According to a recently released federal report, there was a very substantial increase in visits to acupuncturist between 1997 and 2007.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. Furthermore, median out-of-pocket patient payments to acupuncturists and massage therapists were more than twice what is typically paid to chiropractors and osteopaths, who were are among the lowest paid to complementary and alternative health care providers.
The report by the National Center for Health Statistics showed that typical out-of-pocket cost was $48 for acupuncture and $47 for massage, versus about $22 for chiropractic or osteopathic manipulation. 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. For acupuncture, the number of visits per year was 2.42, while for massage it was 2.16 visits. Because the report merged chiropractic and osteopathic manipulation therapies, it wasn't clear what was the true number of visits to chiropractors. However, based on the data, the median number of patient visits for chiropractic or osteopathic manipulation was 3.45 times per year.
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 CAM 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 in a 1997 study in JAMA by David M. Eisenberg, MD.1
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 and 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 full report can be downloaded at the NHIS Web site.
- Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998 Nov 11;280(18):1569-75.