At a recent conference of the North American Spine Society, a colleague of mine was sitting at a table with an insurance company medical director. She told him she likes chiropractic care personally, but her company prefers PTs to deliver care for spine patient enrollees. Many of the studies show that chiropractic care can cost up to two 2/3 less while having fewer reoccurrences of most back, neck, and other musculoskeletal conditions. These studies were in well-respected journals. Even Unitied Healthcare's Optum division testified that chiropractic care saved them millions of dollars. Do insurers want to offer us the best care and save us money? Actions speak louder than words. A study assessed the medical records of 14,787 patients and was published in the Journal of the American College of Occupational and Environmental Medicine. The research team consisted of four PhDs, two PharmDs and one MD(1). Study participants were employees of a heavy equipment manufacturer who were mostly male, in their late 40s, and with an above-average middle-class income. Subjects were divided into two main categories, depending upon their presenting symptoms: low back pain with neurological symptoms and low back pain without neurological symptoms. Total costs, as defined for this study, included imaging, health care professional visits, medications, injections, surgery, and disability payments. The graph titled "Total Cost of Care Over 3 Years" tells a powerful story about the conclusions of this study. Total costs for low back pain patients with neurological findings were $6,983 for chiropractors vs. $17,194 for physical therapists. Total costs for low back pain patients without neurological findings were $6,768 for chiropractors vs. $13,449 for physical therapists. That is an enormous difference! This study also examined why chiropractors are more cost-effective. It determined that chiropractors are less likely than physical therapists to recommend incongruent health care services for patients with low back pain, such as imaging, medications, injections, and surgery. Another study examined the recurrence rate of back pain after a back injury among three types of health care providers: medical doctors (who served as the reference group), chiropractors, and physiotherapists (2). The study was conducted by four PhDs and one Doctor of Science and was published in the Journal of Occupational Rehabilitation. This research team analyzed data from a cohort of 5,511 workers with an initial episode of back injury. The graph titled "Occurrence Rate of 2nd Episode (MDs as reference=0%)" demonstrates the conclusions of this study. The type of health care provider first visited for back pain was a determinant of recurrence. Chiropractic patients experienced the fewest recurrences (-19 percent compared to MDs), while physiotherapy patients experienced the most (49 percent). These differences raise concerns regarding the use of physiotherapists as gatekeepers for spinal injuries. There are more than two dozen studies that point in one direction: Chiropractic services are more economical than physiotherapist services, and chiropractors are more effective in the treatment of spinal conditions than physiotherapists. Health care consumers are stumped when their hospital system or insurance carrier sets up tiers to make a more effective service such as chiropractors cost more than a less effective but more costly service. Even with regards to Medicare, the gold standard for senior care, it only covers manipulation, and patients are required to pay for the other services out of pocket. The good news is that The Medicare Modernization act, a bipartisan bill which is steadily gaining cosponsors in the house and companion bills in the senate are recently launched which can help level the playing field for healthcare consumers. You can read more about that bill here. You can use the link to contact your senators and congressman and ask that they help cosponsor this bill. Chiropractors have the ability to lower Medicare costs while reducing unnecessary tests and improve the quality of outcomes. If you work for an organization that has a self insured plan that does not cover chiropractic, you should demand that they do and share these studies with them. Healthcare consumers should demand effective and cost effective care. The good news is that even without coverage, chiropractic care has always been affordable and accessible. Choose chiropractic first for your musculoskeletal condition. Do you need chiopractic help now? Request an appointment using this link. References Allen H, Wright M, Craig T, et al. Tracking low back problems in a major self-insured workforce: toward improvement in the patient's journey. J Occup Environ Med, 2014;5:604-20. Blanchette MA, Rivard M, Dionne CE, et al. Association between the type of first healthcare provider and the duration of financial compensation for occupational back pain. J Occup Rehabil, 2017;27:382-392.