Utilization and costs of chiropractic care for work-related low back injuries: do payment policies make a difference?

Abstract

Chiropractic care is frequently used in the treatment of work-related low back pain. Chiropractors have been shown to be more sensitive to cost-sharing than other providers. This study examined the differences in utilization and costs of chiropractic care for work-related low back injuries in seven jurisdictions and whether these differences can be associated with workers' compensation (WC) payment policies. A retrospective analysis of WC data from a single insurer. Analyzed data included individuals with chiropractic care performed between 1999 and 2002. Utilization (visits and services per person, services per visit) and costs (cost per person and cost per visit) were examined. Actual reimbursement index was developed to proxy payment policies based on actual payments made to chiropractors. Utilization and costs varied significantly across the analyzed states. Restrictive payment policies were associated with lower costs of chiropractic care and lower number of services per visit, but had no impact on visits or services per person. Findings indicate necessary components of effective cost containment, even in the presence of utilization adjustment.