The epidemic of neuromusculoskeletal disorders (NMSD)/(soft tissue diseases) such as back pain, neck pain, headaches, carpal tunnel syndrome, shoulder sprains and muscle strains According to Bureau of Labor Statistics, NMSD now account for 62% of all occupational illnesses and one third of Worker’s Compensation costs.
The most common MSD are back cases. 80% of all adults report significant back pain, and 30-405 of all compensation costs are related to low back injuries alone. According to the national Center for Compensation Insurance, the average case cost was $23,916. The epidemic of back pain costs between $60-$100 billion with over $30 million annually. It is the leading reason for disability for people under 45years, the second leading reason for visits to doctor’s office, and the third leading reason for hospital admissions.
Carpal tunnel syndrome (CTS) increased by 55% between 1991 and 1994, accounting for 2.6% of all compensation cases, and the average cost of a CTS case is $13,526.Office employees such as computer operator’s account for about 20% of CTS cases.
Purpose: To lower the costs of health care without affecting quality and production.
Solution: use of chiropractic care /coverage as a means of reducing health care costs, and attaining better health outcomes.
Address the problem proactively
Develop employer/employee coalitions mutually interested in health promotion and health care cost reductions.
Efficacy of Chiropractic care
Research shows that chiropractic treatment for musculoskeletal disorders is safe, effective; results in long term benefit for the patient, and cost less.
The Us Public health service authorized a two-year study
headed by a 23 member expert panel to investigate this epidemic. Their
conclusion came from a review of over 4,000 articles from the library of
Congress and the National Library of Medicine. Their conclusion shocked the
medical world when they stated that…
“Even having a lot of back pain does not by itself mean you need back surgery. Surgery has been found to be helpful in 1 out of 100 cases of low back problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain.”
This expert panel now recommends spinal manipulation as initial form of treatment for this “epidemic” Bigos, S.et al., Understanding Acute Low Back Problem in Adults. AHCPR Pub. No. 95-0644, Dec. 1994.
Recently, the president of Orthopedic Association stated that 95% of spine surgery for back pain was inappropriate.” Butts, WP, St. James University Hospital, British Journal of Rheumatology.
“…for the management of low back pain, chiropractic care is the most effective treatment and should be fully integrated into the government’s health care system” The Manga Report, 1993.
“Our trial showed that chiropractic is a very effective treatment, more effective than conventional hospital outpatient for low back pain…particularly in patients… who have severe problems.” T.W. Meade, M.D.
“Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain.” British Medical Journal, 1990.
British Medical Research Council Study.
“…spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain.” The Manga Report, 1993.
“…one of the unexpected findings…looks as though the treatment that the chiropractors give does something that results in a very long term benefit.” T.W. Meade, M.D., CBC Radio.
M. D.s now categorize chiropractic manipulation with the highest rating. “Generally accepted, well-established and widely used.” Spine, 1991. North American Spine Society.
“The only difference that I can see is that the patients at John F. Kennedy get chiropractic manipulations. And with my experience, the patients at J.F.K. almost without fail get out of the hospital in a week. At Lutheran, it usually takes, oh, not uncommonly, 14 days.”
Per Frietag, M.D., an orthopedic surgeon, on why he prefers to admit his patients with back pain to John F Kennedy Hospital, which has staff chiropractors, rather than Lutheran General, which does not have staff chiropractors.
Chiropractic is significantly less expensive than treatment managed by M.Ds. It can get injured employees back to work quickly and safely and save business millions of dollars in lost productivity.
.”…the injured workers…diagnosed with low back pain returned to work much sooner when treated by chiropractors than by physicians.” The Manga, 1993
Of 1,996 low back pain case studied, patients receiving chiropractic treatment returned to work 4 times faster (6.26 days vs. 25.56 days) and had treatments 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 significantly lower incidence of progression to a chronic low back pain status. Chiropractic Journal of Australia, 1992.
“Mechanical Low Back Pain: A Comparison Of Medical and Chiropractic management.
“The mean compensation cost (not treatment costs) paid out by the Utah Worker’s compensation Board for patients treated by medical doctors was $668.39; the mean compensation cost paid for patient treated by chiropractic was only $68.38.”
Journal of Occupational Medicine, 1991.
“Cost per case Comparison of Back Injury Claims for Chiropractic vs. Medical management for conditions with Identical Diagnostic code.”
Total medical costs for back related injuries cost the Utah Worker’s Compensation Board an average of $1,665.43 per case; chiropractic costs for similar diagnoses cost only $775.30 D.C. Tracts, 1989.
“Cost per Case analysis of Utah Industrial Back injury Claims: Chiropractic Management vs. Medical Management for diagnostically equivalent Conditions.’
Medical payments for back related injuries cost Florida worker’s Compensation Board $1,100 per case; chiropractic treatment for similar diagnoses cost only $558. ACA Journal of Chiropractic, 1988.
“An analysis of Florida Worker’s Compensation medical Claims for back related Injuries.
The Oakland University Study
After reviewing the health insurance claims for 395,641 chiropractic and medical care patients, Miron Stano, Ph.D., lead researcher, concluded:
Those patients who received chiropractic care, either solely or in conjunction with medical care, experienced “significantly lower health costs… on the order of $1,000 each over the two year period” compared with those who received only medical care.
Specifically, total insurance payments were $1,138 (30%
higher) for those who elected medical care only. The lower costs for
chiropractic patients were attributed both to lower patient and outpatient
costs and indicated that chiropractic treatment substitutes for other forms
of outpatient care
“Mechanical Low Back Pain: A Comparison of Medical and Chiropractic Management.”
A Study done which included 80 patients, each of whom was previously treated by a medical doctor and subsequently referred to the Silverman Chiropractic Center. Of these 80 patients, 21% had been diagnosed with disc problems, 5% received emergency room treatment and 12% had been diagnosed as requiring surgery.
Following Chiropractic treatment, no surgery was required. 86% needed no further treatment at all. And the projected savings on the patient study was approximately $250,00. The Av-Med Study, 1993.
“There would be highly significant cost savings if more management of low back pain was transferred from physicians to chiropractors… Users of chiropractic care have substantially lower health care costs, especially inpatient costs, than those who use medical care only.” The Manga Report, 1993.
“The overwhelming body of evidence shows that chiropractic management of low back pain is more cost effective than medical management, and that many medical therapies are of questionable validity or are clearly inadequate…chiropractic manipulation is safer than medical management of low back pain.’
Patient Evaluation of Care Chiropractor family Doctor
Mean # of days incapacitated after first visit 10.8 39.7
Restricted for more than one week 17% 48%
Patient perception of doctor’s confidence in
Diagnosing and treating low back pain 60% 23%
Satisfaction 66% 22%
“Patient Evaluations of Care from Physicians and chiropractors.”
ACA Journal of Chiropractic, 1989.
Expenditure to improve access to chiropractic services, and changed utilization patterns it produces, will lead to very significant net savings in direct and indirect costs. Reduction in health care costs, improved health outcomes, and equitable access to services are important objectives for the health care system. All these will be sufficient reasons for the proposed in funding chiropractic services.
Develop employer/employee coalitions: mutually
interested in health promotion and healthcare cost reductions. When employers
empower valued and respected employees with useful knowledge and
self-management procedure, employees do take constructive action. Belief in
people is a powerful often overlooked tool for solving human problems. Finally,
if worker’s compensation problems are to be resolved, employers and employees
must trust their capacity for cooperative enterprise. In the final analysis,
it is the Partnership that works!