This study compared the characteristics and costs associated with extensive and sporadic users of chiropractic services.
A retrospective study design was used, utilizing year 2017 nationally representative Medical Expenditure Panel Survey (MEPS) database. Adults age 18 and older with at least one chiropractic visit were included in the study. Extensive chiropractic utilization was defined as 6 or greater visits to a chiropractor within any two-month time-frame or at least 12 total visits, in 2017. This is a conservative definition consistent with American Chiropractic Association (ACA) low back pain treatment guidelines and the International Chiropractors Association (ICA) best practices and guidelines for treatment duration and frequency. Sporadic use was defined as not meeting the criteria for extensive use. Factors compared include proportion of costs paid out-of-pocket, region, race, age, health insurance status, and employment status. Comparisons between the groups were made with Chi-squared tests and t-tests for categorical and continuous variables, respectively. Analyses conducted with SAS version 9.4, significance set at 0.05.
There were 4,373,580 (22.7%) and11,163,515 (77.3%) adults classified as extensive sporadic chiropractic-users, respectively. The mean (95% CL) total cost of chiropractic services was and $2070 ($1750-$2390) (33% out-of-pocket) and $348 ($314-$382) (47.4% out-of-pocket) for extensive and sporadic users respectively, with the proportion paid out-of-pocket significantly different between the groups. Significant difference was detected between extensive and sporadic chiropractic-users for employment status (employed for full-year)[30.0% versus 36.7%] and sex[44% Male versus 39% Male]. Age, Family income, Region, race, and insurance coverage were not significantly different.
Most chiropractic users were sporadic users, which may indicate inefficiencies in treatment based on ACA and ICA treatment guidelines. Significant differences were detected among characteristics and proportion of costs paid out-of-pocket between extensive and sporadic users of chiropractic services. Future research should investigate the appropriateness of treatment and cost-effectiveness of treatment among this population.
© 2020 Published by Elsevier Inc.