The database developed for this study contained data on over 2 million beneficiaries in the fee-for-service sector, making it the largest known source of private-sector information on chiropractic claims payments. The database contained claims for 396,000 patients, including 93,000 chiropractic patients, with data from medical and chiropractic claims for 493 diagnostic codes. Payment comparisons are consistent with the view that chiropractic substitutes for other forms of care. Overall, the group receiving medical treatment only, has mean insurance payments 30% higher than the group receiving both chiropractic and medical care.

The Utah Study

"Chiropractic patients return to work ten times sooner at ten times less cost"
A 1991 study of workers' compensation claims comparing medical care to chiropractic care and reported in The Journal of Occupational Medicine found that chiropractic patients return to work ten times sooner after and injury. An interesting quote from the article was:

For the total data set, cost for care was significantly more for medical claims and compensation costs were ten-fold less for chiropractic claims.

This study is important because it involved 3,062 separate injury cases. The sample consisted of 40.6% of the 7,551 estimated back injury claims from the 1986 Workers' Compensation Fund of Utah.

Western Journal of Medicine

"Chiropractic patients report greater satisfaction than do medical patients"

A study reported in the March 1989 issue of the respected Western Journal of Medicine compared satisfaction of chiropractic and medical patients from Group Health Cooperative, a large Seattle HMO. Researchers there found that low back pain patients evaluated their chiropractic doctors highly in critical patient care areas while medical doctors received much lower marks. Patients generally gave chiropractors a three-to-one advantage in five important areas of satisfaction. Chiropractic patients in the study also reported quicker recoveries.

Manga Report

"Safer and more effective"
A new report says that hundreds of millions of dollars can be saved by transferring management of low back pain to chiropractors. Widely known as the Manga Report after health economist Pran Manga, Ph.D., the study's conclusions are remarkable in their support of chiropractic care over traditional medical care for low back pain. In fact, the report recommends that chiropractors be consulted first, as the gatekeepers for treatment of low back pain for cost-effective treatment. Funded by the Ontario Ministry of Health, this report establishes the superiority of chiropractic spinal manipulation over the use of drugs, surgery, bed rest and various physical therapy procedures in treating low back pain. Excerpts from the report follow:

On efficacy... ...spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain.

On safety... ...the literature suggests that it (chiropractic) is not only very safe but much safer than medical and other professional management of low back pain.

On medical research... ...It is surprising to discover how 'unscientific' traditional medical therapies for low back pain are, and further, how slowly clinical research affects actual medical practice. Most low back surgery is not founded on evidence from randomized or even non-randomized trials.

Recommendations... ...In our view, the constellation of evidence offers an overwhelming case in favor of much greater use of chiropractic services for the management of low back pain... A very good case can be made for making chiropractors gatekeepers for management of low back pain in the workers' compensation system in Ontario.

Other chiropractic benefits... ...In our review we came across many studies that support the effectiveness of chiropractic care for headache and migraine, neck pain and referred and radiating pain, an a variety of other ailments.

Abstracts

Numerous studies have shown that chiropractic treatment is both safe and effective.  The following are excerpts from a few of the more recent studies.  By examining the research supporting chiropractic care, you will find that chiropractic offers tremendous potential in meeting today’s health care challenges.

For Acute and Chronic Pain

“Patients with chronic low-back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for chiropractic patients. A higher proportion of chiropractic patients (56 percent vs. 13 percent) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse.”

– Nyiendo et al (2000), Journal of Manipulative and Physiological Therapeutics

In a Randomized controlled trial, 183 patients with neck pain were randomly allocated to manual therapy (spinal mobilization), physiotherapy (mainly exercise) or general practitioner care (counseling, education and drugs) in a 52-week study. The clinical outcomes measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care. Moreover, total costs of the manual therapy-treated patients were about one-third of the costs of physiotherapy or general practitioner care.

-- Korthals-de Bos et al (2003), British Medical Journal

In Comparison to Other Treatment Alternatives

 “Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction; clinically important differences in pain and disability improvement were found for chronic patients.”

– Haas et al (2005), Journal of Manipulative and Physiological Therapeutics

“In our randomized, controlled trial, we compared the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner in patients with nonspecific neck pain. The success rate at seven weeks was twice as high for the manual therapy group (68.3 percent) as for the continued care group (general practitioner). Manual therapy scored better than physical therapy on all outcome measures. Patients receiving manual therapy had fewer absences from work than patients receiving physical therapy or continued care, and manual therapy and physical therapy each resulted in statistically significant less analgesic use than continued care.”

– Hoving et al (2002), Annals of Internal Medicine

 For Headaches

 “Cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache.”

-- Duke Evidence Report, McCrory, Penzlen, Hasselblad, Gray (2001)

“The results of this study show that spinal manipulative therapy is an effective treatment for tension headaches. . . Four weeks after cessation of treatment . . . the patients who received spinal manipulative therapy experienced a sustained therapeutic benefit in all major outcomes in contrast to the patients that received amitriptyline therapy, who reverted to baseline values.”

-- Journal of Manipulative and Physiological Therapeutics, Boline et al. (1995)

Cost Effectiveness

 “Chiropractic care appeared relatively cost-effective for the treatment of chronic low-back pain. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulative efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis.”

– Haas et al (2005), Journal of Manipulative and Physiological Therapeutics

 Patient Satisfaction

 “Chiropractic patients were found to be more satisfied with their back care providers after four weeks of treatment than were medical patients. Results from observational studies suggested that back pain patients are more satisfied with chiropractic care than with medical care. Additionally, studies conclude that patients are more satisfied with chiropractic care than they were with physical therapy after six weeks.”

-- Hertzman-Miller et al (2002), American Journal of Public Health

Popularity of Chiropractic

 “Chiropractic is the largest, most regulated, and best recognized of the complementary and alternative medicine (CAM) professions. CAM patient surveys show that chiropractors are used more often than any other alternative provider group and patient satisfaction with chiropractic care is very high. There is steadily increasing patient use of chiropractic in the United States, which has tripled in the past two decades.”

– Meeker, Haldeman (2002), Annals of Internal Medicine

Notable Quotes from Current Literature

Chiropractors appear to be well trained and well accepted by both patients and insurers.
  --  Journal of Family Practice

Plans which do not cover chiropractic have the highest payments per patient.
  --  Journal of American Health Policy

Chiropractic Facts

From the Gallop Organization

In 1991, nearly 30% of the U.S. population age 18 and older have used chiropractic.

More Facts to Consider... 

• Chiropractic is the second largest primary health care profession in the United States and the fastest growing primary care profession in the world. There are approximately 50,000 DCs in active practice in the United States spread from rural areas to inner cities. More than 10,000 students are currently studying in chiropractic educational programs accredited by a federally recognized body. Doctors of chiropractic have been licensed and recognized as primary providers for many decades in all 50 states, the District of Columbia and Puerto Rico.
• Doctors of chiropractic provide low-cost care. Studies have consistently shown chiropractic to be a more cost-effective method of caring for neuro-musculo-skeletal conditions, thus offering significant cost-containment potential to our health care system. DCs are trained to employ conservative, early-intervention methods as an alternative to surgical utilization, drug therapy and other high-cost treatments with a high degree of efficiency and patient satisfaction.
• Chiropractic is recognized by governmental health care programs. Chiropractic is included in Medicare, Medicaid, Federal Employees Health Care Benefits Programs, Federal Workers' Compensation and state workers' compensation programs. Chiropractic students are qualified to receive federal student loan assistance and DCs are authorized to be commissioned as health care officers in the US Armed Forces.
• Doctors of chiropractic receive extensive, demanding professional education on par with other primary health care providers. To receive the degree of doctor of chiropractic, candidates must complete extensive undergraduate prerequisites and complete four years of resident, full-time instruction in an accredited program. Students are thoroughly trained in the appropriate use of sophisticated diagnostic technology including X-ray, laboratory procedures and other state-of the-art investigative technologies. The capacity to fully evaluate the health care needs of the patients, including appropriate referrals to other health professionals when necessary, is an important objective of chiropractic education.
• Chiropractic services are in high demand. Tens of millions of American consumers routinely opt for chiropractic services and this number is rapidly growing. In 1993, more than 30 million consumers made chiropractic a regular part of their health care program, even though personal out-of-pocket expenditures may have been entailed. If there is one primary health care profession that can point to private sector demand and to marketplace viability for economic validation, it is chiropractic. Every day, thousands of consumers decide to spend their own money for chiropractic services when traditional medical care is available to them through insurance or government programs at a more subsidized cost or at no cost at all. Consumers make this choice because of the unique benefits chiropractic has to offer.
• The chiropractic profession is an effective prevention resource. Doctors of chiropractic receive extensive prevention training and are a highly appropriate resource to effectively intervene in matters of nutritional counseling, substance abuse education, prevention and treatment, weight control, smoking cessation, postural correction, workplace safety, stress management, ergonomic design and injury prevention.
• Chiropractic offers a significant alternative to traditional medicine. A recent New England Journal of Medicine article affirmed that Americans made more visits to non M.D. providers (425 million visits) than to all US primary care physicians (388 million visits). Expenditures associated with use of alternative therapy in 1990 amounted to approximately 13.7 billion dollars. The figure is comparable to the 12.8 billion dollars spent out-of pocket annually for all hospitalization in the US. One out of three Americans routinely uses health care other than that provided by traditional medical doctors.
• Doctors of chiropractic care for a wide range of conditions particularly those related to the spine and adjacent structures. Total direct and indirect costs of spinal injuries in this country exceed 60 billion dollars. The highest frequency use of alternative therapy listed was for those people with back problems (30%) and the alternative most commonly chosen was chiropractic. It is less expensive and more effective to utilize chiropractic care than traditional surgical procedures.
• Chiropractic is a very specific science. The practice of chiropractic is based on specific factors of human response to certain anatomical problems, chief of which is the presence of nerve interference related to the bony structures of the human body (particularly the spine) caused by displaced vertebrae, referred to in chiropractic as subluxation(s). The free flow of nerve communication from the brain through the spinal column to all parts of the human body is the basis upon which the body governs itself and all its functions. Chiropractic science has determined that the interruption, blockage or aberration of that flow of information can lead to serious health consequences. Conversely, the removal of that interference has been shown to have important health benefits.
• Chiropractic care has a narrow scope of practice with broad body implications. The anatomical focus of the doctor of chiropractic, the human spine, has created the popular perception of the DC as a back doctor, dealing primarily with back problems. This perception is very much incomplete.
• Chiropractic is a sound, effective alternative to traditional medical treatment for a wide range of conditions, including but by no means limited to back and neck problems, orthopedic conditions and other muscular/skeletal problems. Indeed, patients might benefit most by seeing their doctor of chiropractic first when these conditions arise, and realize, in consequence, marked improvement in their profile of general health.
• All organs of the human body need proper nerve energy and information flow to function properly. The detection and correction of spinal subluxation(s), a local condition in the area of the human spine, has broad body implications. Knowing as we do the intricate connections between the nervous system, the immune system and all the systems of the human body, it is not surprising that chiropractic care can be of help.
• The International Chiropractors Association defines the science of chiropractic as follows: "The science of chiropractic deals with the relationship between the articulations of the skeleton and the nervous system, and the role of this relationship in the restoration and maintenance of health. Of primary concern to chiropractic are abnormalities of structure or function of the vertebral column known clinically as the vertebral subluxation complex. The subluxation complex includes any alteration of the biomechanical and physiological dynamics of contiguous spinal structures which can cause neuronal disturbances."
• The practice of chiropractic is based upon the principles contained in this definition. Its practice is also based upon the judgment and skill developed through a comprehensive professional education which is provided in the accredited institutions that train chiropractic students as primary health care providers. This education, as provided within the US chiropractic college system, is approved by the commission on Accreditation of the Council on Chiropractic Education and by regional accrediting agencies. All of these accrediting bodies are recognized by the United States Department of Education.
• The International Chiropractors Association describes the chiropractic adjustment to include "the adjustment of the spinal vertebrae, the sacrum, the ilia, the coccyx and other skeletal articulations", based on the use of "analytical and diagnostic x-rays of the skeletal system and its adjacent tissues; those procedures necessary to interpret disorders of the neuromuscular skeletal system and the use of physical, clinical and laboratory diagnostic procedures to ascertain the nature of the patient's problem and respond accordingly." On the basis of a thorough study of the patient, the doctor of chiropractic accepts the case and/or refers it to another health care provider for consultation or care. The physical realignment of bony structures and tissues to relieve nerve interference is a complex process for which the doctor of chiropractic is expressly trained and uniquely qualified through thousands of hours of classroom and clinical instruction. No other health profession devotes this degree of serious scientific study to the human spine and its relationship to human health.
• The process of chiropractic adjustment is a safe, efficient health care procedure performed nearly one million times every working day in the United States. Negative "disinformation" about the safety of chiropractic has historically been employed by competitors in the health care marketplace to frighten individual consumers as well as to influence public policy decision makers.
• Assertions about the safety of chiropractic care can be credibly dealt with in several compelling ways. First, there is a singular lack of actuarial data that would justify the conclusion that chiropractic care is in any way harmful or dangerous. The greatest repositories and investigators of this type of data in the world, the US insurance industry, routinely include chiropractic services as part of most health insurance plans. They also offer to insure chiropractic practitioners against claims of malpractice, at rates that are substantially lower than those of medical practitioners, despite the fact that, on average, chiropractors routinely see more individual patients on any given day than medical doctors.
• Chiropractic care is safer than other methods of health care. In 1989, the average annual cost of malpractice insurance coverage for the US medical doctor was $15,500. The average annual cost for similar coverage for doctors of chiropractic in that same year was less than a third of this figure.
• On the question of chiropractic safety, some credit must be given to the judgment and the findings of the public authorities in the US and around the world who have seen fit to license and pay for chiropractic services for decades. Perhaps the best summary statement on this question was published in 1979 by the Government of New Zealand, which established a special commission to study chiropractic. "The conspicuous lack of evidence that chiropractors cause harm or allow harm to occur through neglect of medical referral can be taken to mean only one thing: That chiropractors have on the whole an impressive safety record."

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