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July 30, 2009  
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CAM Costs Reported in Federal Survey

By Ramon G. McLeod, Editor-in-Chief

Median out-of-pocket patient payments to chiropractors and osteopaths are among the lowest paid to complementary and alternative medicine (CAM) practitioners and were less than half what is typically paid to acupuncturists and massage therapists, according to a federal report released today.

The report by the National Center for Health Statistics (NCHS) showed that typical out-of-pocket costs for chiropractic or osteopathic manipulation was about $22 versus $47 for massage and $48 for acupuncture. The report, a follow-up to an NCHS study released earlier this year, was based on a 2007 survey of 29,000 U.S. households.

The report did not include data on insurance-reimbursable patient visits and should therefore not be viewed as the average payment made to a practitioner.

The study also included data on the median number of visits to a practitioner in the last 12 months. Because it merged chiropractic and osteopathic manipulation therapies, it was not clear what the true number of visits is to chiropractors. However, based on the data, the median number of patient visits for chiropractic or osteopathic manipulation was 3.45 times per year. For acupuncture the number was 2.42 while for massage it was 2.16 visits.

In commentary accompanying the spending report, the government reported that more than $34 billion was spent on out-of-pocket costs for visits to practitioners ($12 billion) and on self-care purchases of CAM products, classes and materials ($22 billion).

A Drop In Patient Visits, Spending?

The most controversial element of the report was a statement in the commentary section that compared CAM spending in 2007 and the spending reported out in a 1997 study by D.M. Eisenberg.

The authors of the 2007 report said that overall spending on self-care products and services had increased since 1997 while payments to all CAM practitioners had decreased from $16 billion to $12 billion two years ago. Practitioners included in the report ranged from chiropractors, massage therapists, acupuncturists, to naturopaths, homeopaths, energy healers, and others.

The commentary said visits to CAM therapists of all types had dropped 50 percent since 1997, a staggering decline. At least half of the overall decline was attributed to a decrease in visits to "practitioners of energy-healing therapies and various relaxation techniques."

However, after including this dramatic material, the authors offered no data on the visit patterns for massage therapists and chiropractors. When pressed about this during presentation on the report, the authors said that direct comparisons on visits could not be made for those two professions due to the differing methods used by the 1997 and 2007 reports.

The report did note a very substantial increase in visits to acupuncturists. The number of patient visits per 1,000 people jumped from 27.2 visits in 1997 to 79.2 visits per 1,000 in 2007.

The full report can be downloaded at the National Center for Complementary and Alternative Medicine (NCCAM) Web site.

 

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