HEALTH SERVICE RESEARCH POSTER PRESENTATION ABSTRACTS
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THURSDAY, 5:30-6:15 PM

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Lafferty WE, Tyree PT, Bellas AS, Watts CA, Lind, BK, Sherman KJ, Cherkin DC, Grembowski DE.

Complementary and alternative medical providers and third party reimbursement: how will insurance expenditures and health care utilization change?

Department of Health Services; School of Public Health and Community Medicine; University of Washington billlaf@u.washington.edu

PURPOSE: After the Washington State legislature required health insurance companies to include licensed CAM providers in their benefits, we evaluated CAM insurance claims and CAM expenditures from 1.7 million Washington State residents.

METHODS: Calendar year 1997, 2000, and 2002 insurance claims from three of Washington State's largest underwriters were used for this analysis. CAM and conventional provider utilization, demographic data, and diagnosis were described for three cross sectional temporal cohorts.

RESULTS: Among the 1.7 million enrollees, the proportion with claims for any kind of health care increased from 80.5% in 1997 to 83.4% in 2002. Claims for naturopathy, acupuncture, and massage were made by 4.6% of enrollees in 2002, up from 1.5% in 1997. Enrollees using chiropractic treatment increased from 7.6% to 10.9% from 1997 to 2002 however the proportion of all visits for chiropractic increased less than 1%. Twice the number of patients used CAM in PPO products compared to HMO coverage (15.3% vs. 7.7%). CAM use was greater in women and people over 40 years of age. Chiropractic use was more frequent in less populous counties. Diagnoses treated by CAM providers were usually focused on musculoskeletal complaints with the exception of naturopathic physicians who treated a broader array of medical conditions. Total medical expenditures inflation adjusted in 2002 dollars increased from $1,530 in 1997 to $2589 in 2002. Prior to 2002, CAM provider expenditures were 2.6% of the total and in 2002, they were 2.9% of the total expenditures. Expenditures for chiropractors decreased from 2.2% to 1.6% while expenditures for other CAM providers increased from .4% to 1.3% of total medical expenditures.

CONCLUSIONS: Although the number of people submitting claims for CAM increased substantially since 1997, the overall effect on insurance expenditures has been modest. Some of the newly covered services may be substitutes for chiropractic care (for which some coverage was available before 1996). Because the ultimate trajectory of CAM utilization is not known, future utilization of these services should be followed.

 

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