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Cost Effectiveness of Chiropractic Care


A sampling of peer-reviewed publications regarding the cost and treatment effectiveness of chiropractic care compared to other licensed health care professions.

Compiled by Carrie Goettsch DC    6/17/2011     carriegoettsch@hotmail.com


This 1988 Utah workers' compensation board study found a tenfold savings for mean compensation costs in back-related injuries treated by chiropractors as compared with medical doctors ($68.38 vs. $668.39). To ensure accurate and true results, only those back-related injuries with the same diagnostic codes were compared between the two treatment groups. Also, the medical treatments assessed were limited to nonsurgical medical treatments only.

Cost per Case Comparison of Back Injury Claims of Chiropractic versus medical Management for Conditions with Identical Diagnostic Codes. Jarvis KB, et al. Journal of Occupational Medicine - 1991;33:847-52.



This large State of Florida study examined 10,652 patients who sustained back-related injuries on the job. Their findings revealed that individuals who received chiropractic care compared with standard medical care for similar diagnoses experienced had a 51.3 percent shorter temporary total disability duration, lower treatment cost by 58.8 percent ($558 vs. $1,100 per case), 20.3 percent hospitalization rate in the chiropractic care group vs. 52.2 percent rate in the medical care group.

An Analysis of Florida Workers' Compensation Medical Claims for Back Related Injuries. Wolk S. Foundation for Chiropractic Education and Research, Arlington, VA. - 1988.



Richard Wolf, M.D. followed 500 individuals sent for chiropractic treatments and 500 individuals sent to medical doctors for treatment. Those who received chiropractic treatments returned to work in an average of 15.6 days vs. 32 days in those who received treatments from medical doctors.

This Oregon study found that individuals with workers' compensation claims returned to work significantly faster under chiropractic care compared with medical care. In fact, under chiropractic care 82% were able to return to work after one week compared with only 41% in those who received medical care.

A Study of Time Loss Back Claims. Portland, OR. Workers' Compensation Board, State of Oregon, March 1971. 

Industrial Back Injury. Wolf CR. International Review of Chiropractic - 1974;26:6-7.



In this Australian study, 1,996 workers' compensation cases were evaluated in patients who experienced work-related mechanical low back pain. It was found that those individuals who received chiropractic care for their back pain returned to work 4 times faster (6.26 days vs. 25.56 days) and had treatment that cost 4 times less ($392 vs. $1,569) than those who received treatments from medical doctors. Also, in those patients who received chiropractic care there was a significantly lower incidence of progression to a chronic low back pain status.

Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian Work Care Scheme. Ebrall, PS. Chiropractic Journal of Australia - 1992;22:47-53.


According to this Canadian government commissioned study, "...injured workers ... diagnosed with low-back pain returned to work much sooner when treated by chiropractors than by physicians."

The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.



The British Medical Research Council’s Back Pain, Exercise and Manipulation (BEAM) Trial published in  2004(8) followed an earlier large MRC trial by Meade et al. reporting cost-effectiveness of chiropractic management of acute and chronic back pain patients.(9,10) The 17 member multidisciplinary BEAM trial  panel concluded that their trial “shows convincingly” that skilled manipulation is a cost-effective addition to best medical care in general practice – and that it should be made generally available to back pain patients through the British National Health Service (NHS).

 8 United Kingdom Back Pain Exercise and Manipulation (UK BEAM) Randomised Trial: Effectiveness of Physical Treatments for Back Pain in Primary Care, BMJ Online First, Nov 19, 2004:1-8.

9 Meade TW, Dyer S et al (1990) Low-Back Pain of Mechanical Origin: Randomised Comparison of Chiropractic and Hospital Outpatient Treatment, Br Med J 300:1431-37.

10 Meade TS, Dyer S et al (1995) Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low-Back Pain: Results from Extended Follow Up, Br Med J 311:349-351.


US health economists, analyzing records from the Michigan health benefits consulting firm MedStat Systems Inc. At that time MedStat monitored coverage for 2 million patients across the US. Analyses are for the 2 year period July 1988 to June 1990 and: a) The studies look at chiropractic and medical use and costs for 208 ICD-9 Code diagnoses for various conditions in patients who were equally free to choose medical or chiropractic care for these conditions under the terms of their employment health benefits plans. The entire claims history and all costs for these patients were known. b) After analysis to ensure matching populations in all material respects (e.g. severity of complaints, age, sex, location, insurance plan type, similar access and deductibles for chiropractic and medical care, etc.) the study group was 7,077 patients. c) Medical care costs were significantly higher. For the 9 high frequency ICD-9 Codes most typically used by both chiropractic and medical doctors, mostly involving back and sacroiliac disorders including disc degeneration and sciatica, medical payments were 47% higher for outpatient care, 61% higher for total care. 9. In 2004 Antonio Legorreta, MD MPH, from the School of Public Health, University of California, Los Angeles and colleagues presented a four year claims data analysis for approximately 1.7 million members of a large regional managed care network in California.13 This study, much larger than any previous one, addressed clearly for the first time the question of whether insured chiropractic benefits, even if potentially cost effective, would actually be used as a substitute for medical services by patients who could choose either. Would there be substitution of services, or would chiropractic services simply end up as an addition to total services and costs? This could be determined because all 1.7 million members had a plan with identical medical services, but 700,000 members also had access to a chiropractic benefit. It was found: a) Virtually all chiropractic services used by plan members with access to them were used in direct substitution for medical services. b) This applied not only for back pain but for all conditions seen by chiropractors – over a range of 654 ICD-9 Codes covering neuromusculoskeletal (NMS) disorders such as spinal pain, rib disorders, headache, extremity problems and myalgias or arthralgias. c) A large number of those with access to medical and chiropractic benefits were willing to choose, and did choose, chiropractic care. Of those with NMS complaints, 34.4% or approximately 1 in 3 used chiropractic care. For back pain, both uncomplicated and complicated, 45.9% or nearly half chose chiropractic care.14 d) The 700,000 patients with the added chiropractic benefit had significantly lower claims costs per person than the other 1 million, not only for back pain and NMS problems, but also for total health care costs. At the most conservative estimate the overall annual saving was $16 million. With back pain, for example, the savings in the 700,000 cohort with chiropractic care available were: • Overall cost reduced by 28%. • Reduced hospitalization of 41%. • Reduced back surgeries of 32%. • Reduced cost of medical imaging, such as x-rays or MRIs, of 37%. These figures actually under-estimate the savings achieved. First of all overall cost does not include medications since that data was not captured. Second the above results  compare total costs for the 700,000 cohort with medical and chiropractic benefits (Cohort M+C) with the one million Cohort with medical benefits only (Cohort M) – not just the patients in Cohort M and C who used chiropractic care. Most in Cohort M + C who made a claim for back pain (54.1%) actually saw an MD on the same basis as those in Cohort M – and those medical costs are included in the above figures.

11 Stano M, Smith M. 1996). Chiropractic and Medical Costs For Low-Back Care, Med Care 34:191-204.

12 Smith M, Stano M. (1997). Cost and Recurrences of Chiropractic And Medical Episodes Of Low-Back Care, J Manipulative Physiol Ther, 20:5-12.

13 Legorreta AP, Metz RD, Nelson CF et al. (2004) Comparative Analysis of Individuals with and Without Chiropractic Coverage, Patient Characteristics, Utilization and Costs, Arch Intern Med 164:1985-1992.

14 Metz RD, Nelson CF et al. (2004) Chiropractic Care: Is It Substitution Care or Add-on Care in Corporate Medical Plans? JOED, 46:847-855

 Sarnat Rl, Winterstein J, Cambron J (2007) Clinical Utilization and Cost Outcomes from an Integrative Medicine Independent Physician Association: An Additional 3-Year Update, J Manipulative Physiol Ther 30:263-269.



 Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence Journal of Occupational and Environmental Medicine 2011 (Apr);53 (4):396–404
In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than with chiropractic services or no treatment


A Hospital-Based Standardized Spine Care Pathway:Report of a Multidisciplinary, Evidence-Based Process   J Manipulative Physiol Ther 2011 (Feb);34 (2):98–106
A health care facility (Jordan Hospital) implemented a multidimensional spine care pathway (SCP) using the National Center for Quality Assurance (NCQA) Back Pain Recognition Program (BPRP) as its foundation. The findings for 518 consecutive patients were included. One hundred sixteen patients were seen once and triaged to specialty care; 7% of patients received magnetic resonance imagings. Four hundred thirty-two patients (83%) were classified and treated by doctors of chiropractic and/or physical therapists. Results for the patients treated by doctors of chiropractic were mean of 5.2 visits, mean cost per case of $302, mean intake pain rating score of 6.2 of 10, and mean discharge score of 1.9 of 10; 95% of patients rated their care as "excellent”.


Cost-effectiveness of Guideline-endorsed Treatments for Low Back Pain: A Systematic Review  Eur Spine J. 2011 (Jan 13) [Epub ahead of print]
This systematic review of the cost-effectiveness of treatments endorsed in the APS-ACP guidelines found that spinal manipulation was cost-effective for subacute and chronic low back pain, as were other methods usually within the chiropractor’s scope of practice (interdisciplinary rehabilitation, exercise, and acupuncture). For acute low back pain, this review found insufficient evidence for reaching a conclusion about the cost-effectiveness of spinal manipulation. It also found no evidence at all on the cost-effectiveness of medication for low back pain..


Cost of Care for Common Back Pain Conditions Initiated With Chiropractic Doctor vs Medical Doctor/Doctor of Osteopathy as First Physician: Experience of One Tennessee-Based General Health Insurer
J Manipulative Physiol Ther 2010 (Nov);33 (9):640–643
Paid costs for episodes of care initiated with a DC were almost 40% less than episodes initiated with an MD. Even after risk adjusting each patient’s costs, we found that episodes of care initiated with a DC were 20% less expensive than episodes initiated with an MD. This clearly demonstrates the savings that are possible when a patient is permitted to choose a chiropractor, rather than an MD for their care.


Clinical Utilization and Cost Outcomes from an Integrative Medicine Independent Physician Association: An Additional 3-year Update
J Manipulative Physiol Ther 2007 (May);30 (4):263–269
A new retrospective analysis of 70,274 member-months in a 7-year period within an IPA, comparing medical management to chiropractic management, demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 83% pharmaceutical costs when compared with conventional medicine IPA performance. This clearly demonstrates that chiropractic nonsurgical nonpharmaceutical approaches generate reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone.


Cost-effectiveness of Medical and Chiropractic Care for Acute and Chronic Low Back Pain

J Manipulative Physiol Ther 2005 (Oct);28 (8):555–563
Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction. Chiropractic care appeared relatively cost-effective for the treatment of chronic LBP. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulation efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis. This evidence can guide physicians, payers, and policy makers in evaluating chiropractic as a treatment option for low back pain.


Cost Effectiveness of Physical Treatments for Back Pain in Primary Care
British Medical Journal 2004 (Dec 11);329 (7479):1381 ~ FULL TEXT
We believe that this is the first study of physical therapy for low back pain to show convincingly that both manipulation alone and manipulation followed by exercise provide cost effective additions to care in general practice. Indeed, as we trained practice teams in the best care of back pain, we may have underestimated the benefit of physical therapy (spinal manipulation) when compared with "usual care" in general practice. The detailed clinical outcomes reported in the accompanying paper reinforce these findings by showing that the improvements in health status reported here reflect statistically significant improvements in function, pain, disability, physical and mental aspects of quality of life, and beliefs about back pain


Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs
Archives of Internal Medicine 2004 (Oct 11);164 (18):1985–1892 ~ FULL TEXT
A 4-year retrospective claims data analysis comparing more than 700,000 health plan members within a managed care environment found that members had lower annual total health care expenditures, utilized x-rays and MRIs less, had less back surgeries, and for patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399). The authors concluded: "Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care."


Chiropractic Care: Is It Substitution Care or Add-on Care in Corporate Medical Plans?
J Occup Environ Med 2004 (Aug);46 (8):847-855
An analysis of claims data from a managed care health plan was performed to evaluate whether patients use chiropractic care as a substitution for medical care or in addition to medical care. For the 4-year study period, there were 3,129,752 insured member years in the groups with chiropractic coverage and 5,197,686 insured member years in the groups without chiropractic coverage. These results (of this file review) indicate that patients use chiropractic care as a direct substitution for medical care.


Cost Effectiveness of Physiotherapy, Manual Therapy, and General Practitioner Care for Neck Pain: Economic Evaluation Alongside a Randomised Controlled Trial
British Medical Journal 2003 (Apr 26);326 (7395):911 ~ FULL TEXT
A hands-on approach to treating neck pain by manual therapy may help people get better faster and at a lower cost than more traditional treatments, according to this study. After seven and 26 weeks, they found significant improvements in recovery rates in the manual therapy group compared to the other 2 groups. For example, at week seven, 68% of the manual therapy group had recovered from their neck pain vs. 51% in the physical therapy group and 36% in the medical care group.


Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain. A Randomized, Controlled Trial
Ann Intern Med 2002 (May 21);136 (10):713-722
Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. In this study, manual therapy was a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.



Syracuse Chiropractor | Cost Effectiveness of Chiropractic Care. Dr. Carrie Goettsch is a Syracuse Chiropractor.