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Abstract

A growing number of complementary and alternative therapies are eligible for reimbursement by third party payers in the United States. No studies have examined current trends in the use of public funds for the payment of complementary and alternative medicine (CAM). To determine the reimbursement polices of state Medicaid programs for CAM. Cross-sectional study. 46 state Medicaid reimbursement specialists. Telephone survey. Of the 46 states participating in the study, 36 Medicaid programs (78.3%) provide coverage for at least 1 alternative therapy. The most commonly reimbursed therapies are chiropractic by 33 programs (71.7%), biofeedback by 10 programs (21.7%), acupuncture by 7 programs (15.2%), and hypnotherapy and naturopathy by 5 programs each (10.8%). Many Medicaid programs are paying for the use of CAM. Further research is needed to determine if Medicaid recipients are aware of these reimbursement policies and the extent to which recipients are using CAM for their healthcare.

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... This has also been reported by Miller (1997); Adams et al. (2003) and Al-Faris et al. (2008). While the results of some studies in the USA found that simultaneous use of both healthcare services increased in middle-aged groups (Del & Marose, 2002;Steyer & Lantz, 2002). Traditional and orthodox use of healthcare services increased with lower levels of education. ...
Article
Every society makes provisions for the health care delivery system for its members, this is intending to provide medical and related services for the maintenance of good health, particularly through the prevention and treatment of diseases. This is in recognition of the pervasive importance of good health upon which life is contingent. Despite the development of more researched and formulated orthodox medicines, herbal medicines continue to be well patronized by persons across the world with some patrons concurrently using both forms, oblivious of the unwelcome effects that may occur. The study adopted a descriptive survey research design. For the study, a quantitative approach was used in analyzing the data collected, the population of the study were females between the ages 15-49 with a total of 1081 nursing mothers in Ikenne Local Government Area (LGA), Ogun Nigeria. Sample size determination calculation by Cochran was used to determine the sample size of 190. A multi-stage random sampling, purposive sampling and accidental sampling technique were used to select the respondents. The study revealed that all the social and demographic characteristics of respondents except community had a significant association with respondents’ concurrent usage of herbal and orthodox medicines. It was also observed that 2 in every 10 nursing mothers uses both orthodox and herbal drugs concurrently on their children. The study concluded that 11.05% of respondents concurrently used herbal and orthodox medicines for infant health problems.
... I n 2016, an estimated 50 million people in the United States suffered from chronic pain, 1 which was closely associated with impaired physical and psychological functioning 2 and lost productivity. 3 Studies have shown that race, ethnicity, socioeconomic factors, 4 and insurance reimbursement 5,6 further impact access to pain care. National organizations such as the Joint Commission and the U.S. Department of Health and Human Services have called for reform in pain management in response to the current opioid epidemic. ...
Article
Introduction: Chronic pain and the current opioid epidemic are pressing public health concerns, especially in low-income and ethnically diverse communities. Nonpharmacologic therapies that are safe, effective, and acceptable for the treatment of chronic pain conditions may provide a solution for addressing this issue. This qualitative analysis explores the experience of study participants who received combined acupuncture and yoga therapy (YT) to treat chronic pain delivered in a primary care setting. Methods: The group acupuncture with yoga therapy for chronic neck, low back, and osteoarthritic pain trial (GAPYOGA) assessed the feasibility and effectiveness of group acupuncture (GA) combined with YT in a low-income, racial, and ethnically diverse population. Individual in-depth interviews were conducted with a subset of patients in the trial. Nineteen participants were interviewed for qualitative analysis of their experience. Using the immersion and crystallization method, transcribed interviews were analyzed for themes meaningfully representing participant experience. Results: The combined GA and YT resulted in significant pain relief and transformative healing experiences. Three themes emerged from participant narratives: (1) transformative engagement with self in the healing process through pain relief, psychological well-being, and self-efficacy; (2) therapeutic relationship with acupuncture and yoga providers; and (3) fostering relationships with fellow participants in the group. Discussion: In this study of a low-income and ethnically diverse population, the combination of acupuncture and YT was found to alleviate pain, improve function, promote psychological well-being, and engage participants in self-care practices in a transformative healing process-resulting in physical and psychological benefits.
... Other alternative therapies like yoga, meditation, and spa have been well attributed globally due to their popularity, which led to development in the number of yoga studios, meditation centers, spas, and complementary healing facilities institutes in the particular communities [154][155][156]. Moreover, some alternative medicine services are now offered as benefits in state Medicaid programs, Medicare, and private health insurance plans [157,158]. Study shows that at least 50% American medical schools are currently offering courses in alternative medicine to their medical students. Among which 25.0% of the courses referenced personal growth or self-care through alternative practices, while only 11.0% referenced inter-professional education activities involve interaction with alternative medicine providers [159]. ...
Chapter
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Alternative medicine has renewed its growing public interest in recent times due to inequality of patients and healthcare professionals' ratios with increased work-load for the latter, various side effects of modern medicine, lack of complete remission from chronic diseases, high cost of new drugs, and emerging new diseases. Hence, people have become more dependent on treatment systems replying on alternative medicine or herbal medicine from traditional medicinal practitioners. Alternative medicine has grown substantially over time and encompasses several millennia of therapeutic systems. The significant areas of alternative medicine include mind-body therapies, body manipulation, and the therapies based on biological systems. Natural products based biological treatment is the most popular of them as nature has endowed us with abundance of effective pharmacologically active phytochemicals. These phytochemicals possess numerous specific clinical health benefits including antioxidant, antidiabetic, anti-inflammatory, anticancer, anti-infectious and analgesic effects. In addition, alternative medicine is easily accessible, affordable, most often noninvasive, and provides favorable benefits during terminal periods of some diseases. However, due to the lack of well-designed clinical trials, the safety and effectiveness of many alternative medicines/therapies remains elusive. This chapter will critically discuss major areas, uses, safety and regulation, current challenges & future perspectives of alternative medicine.
... However, access to these "gold standard" approaches to pain management is limited, in part because of lack of insurance reimbursement (Meghani et al., 2012b). In particular, access to CIH is stratified; treatments such as acupuncture and massage are rarely reimbursed by insurance, and high out-of-pocket costs makes them largely inaccessible to people who are uninsured or publicly insured (Steyer et al., 2002;Whedon et al., 2017). Despite high levels of interest in CIH on the part of safety-net clinicians and patients , and regardless of national efforts to transition pain management towards nonpharmacological interventions, safety-net patients often cannot access CIH and other elements of "gold-standard" pain care. ...
Article
Amidst a national crisis of opioid overdose, substantial uncertainty remains over how to safely and effectively address chronic pain. In response to this crisis, safety-net primary care clinics are instituting integrative group medical visits (IGMVs) for chronic pain management. Through two qualitative studies of IGMVs, we found that these groups acted as workarounds implemented by clinicians seeking to innovate upon standard pain management protocols. While clinical uncertainty is often framed as a problem to be managed, in this instance, overlapping uncertainties provided an opportunity through which enterprising clinicians could generate reform at the local level. However, these clinician-led changes were incremental, situational, and partial, and occurred outside of broader systemic reform. In the following article, we draw on 46 interviews with clinicians and staff associated with IGMVs and observations of 34 sessions of 22 distinct IGMVs. We begin by describing the structure of the IGMVs we observed. We analyze the multiple uncertainties surrounding chronic pain and its treatment at the time of our data collection, just before the opioid crisis was declared a national public health emergency. We then demonstrate how clinicians tinkered with existing pain management protocols via their involvement with IGMVs. Lastly, we discuss the conditions of possibility that allowed for the existence of IGMVs at our study sites, as well as the conditions of limitation that restricted the expansion of these groups. Our research points to the potential of IGMVs for treating chronic pain, while showing that IGMVs continue as an innovation by individual clinicians, not as a result of broader reforms.
... CAM laboratory testing is not available via the NHS in UK and is not covered by the national health insurance scheme in Australia but in the US may be covered to some extent by private health insurance plans, Medicare, state Medicaid programmes, and military health insurance plans. 169 In Washington State since 1996, State law has required that private health insurance cover licensed CAM providers. 170 Because CAM laboratories in Australia are not NATAaccredited, patients must pay the full cost of their testing. ...
Article
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It is increasingly easy for the general public to access a wide range of laboratory tests. Tests can be ordered online with little or no input from a health professional. The complementary and alternative medicine (CAM) community promote and sell a wide range of tests, many of which are of dubious clinical significance. Many have little or no clinical utility and have been widely discredited, whilst others are established tests that are used for unvalidated purposes. They range from the highly complex, employing state of the art technology, e.g. heavy metal analysis using inductively coupled plasma-mass spectrometry, to the rudimentary, e.g. live blood cell analysis. Results of 'CAM tests' are often accompanied by extensive clinical interpretations which may recommend, or be used to justify, unnecessary or harmful treatments. There are now a small number of laboratories across the globe that specialize in CAM testing. Some CAM laboratories operate completely outside of any accreditation programme whilst others are fully accredited to the standard of established clinical laboratories. In this review, we explore CAM testing in the United States, the United Kingdom and Australia with a focus on the common tests on offer, how they are reported, the evidence base for their clinical application and the regulations governing their use. We will also review proposed changed to in-vitro diagnostic device regulations and how these might impact on CAM testing.
... This has also been reported by Miller [12] . Adams et al. [13] and Al-Fariset et al. [11] While the results of some studies in USA found that CAM use increased in middle aged groups [14][15][16] . A cross sectional study was conducted among the undergraduate students of Delta State University, Abraka Campus from 24th of March 2013 through April 2013. ...
Article
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Complementary and alternative medicine (CAM) is widely used both as a supplement to conventional or mainstream health care and as part of traditional health care systems and practices. The present work is aimed at studying the knowledge, attitude and practice of CAM by selected adult population living in Bangladesh. A cross-sectional descriptive survey was conducted from September 2016 to March 2017. A total of 300 selected adult population in Gazaria, Munshiganj district. Data were collected by semi structured interviewer administered and pre-tested questionnaire. Among the respondents 153(51%) were male and 147 (49%) were female with mean age of 38.36 years. Mean± SD 38.36±12.548. As regards educational level of the most respondent was 26.7% primary, 23.3%, illiterate, 20.0% SSC, 15% HSC, 10% degree & 5% was masters and above. The study population was 300 among them the highest 90.7% was married and lowest 9.3% was unmarried. The most of the respondents was service holder 30.7%, housewife 20%, farmer 10% and others professional 9.7%. Study result showed that the highest majority family income 44.7% was ranged from BDT20001-BDT30000 taka and lowest 4.7% was BDT50001-BDT60000 taka. Among the study population majority of the respondents, 95.0% did not follow WHO recommended diet chart and 90% did not perform physical exercise. Majority of the respondents lead physically stressed life 75.0%, were mentally stressed 20% and sedentary lifestyle 5%. Among the respondents 95% access TV, 65.3% read newspaper regularly. Among the respondent knowledge level on Complementary and alternative medicine (CAM) showed that about half of the study population 50% had average knowledge, 25% had good knowledge, 15% had poor knowledge, 5% had very poor knowledge 5% had also excellent knowledge on CAM. The study focuses on the awareness of the respondents on CAM. The study showed that highest number of respondents got information's 50.0% from family members, friends or relatives, 26.7% from mass media, 10% from educational academies and 8.3% from others sources. Attitude based statements were presented on a Five-point Likert Scale showed that, This study showed that 30% respondents attitude on scientific basis of CAM were positive, 88.3% were strongly agreed that conventional medicine uses with CAM are beneficial to patient and 80% opined that CAM are easy to access. The majority i.e. 98% strongly agreed to stop unethical practices and 65% suggest to mass media should show awareness raising program on CAM regularly. Overall, there is a positive attitude towards CAM. The study showed that highest number of respondents 97% practices CAM to cure & to prevent various diseases. Among the respondents 35.1% practices traditional healing method. Present study showed that 45.1% practices CAM for lower prices, 45.4% practices for physical debility, 62.1% uses for chronic cases and 39.6% uses CAM from quack like non-qualified practitioners. This study shows that there was statistically significant association between the knowledge level and educational qualification of the study population to CAM.
... 8 In the United States chiropractors are registered providers who participate in many state Med-icaid programs, most private health care insurances, and Medicare. 7,9,10 National Medicare spending on chiropractic care has increased substantially in recent years: from $466 million in 2006 to approximately $700 million in 2011. 11,12 Although chiropractic care has been a covered service since the 1970s, it has recently come under scrutiny by the Office of the Inspector General, [11][12][13][14] and its merits are starting to be questioned by the general public. ...
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Whether availability of chiropractic care affects use of primary care physician (PCP) services is unknown. We performed a cross-sectional study of 17.7 million older adults who were enrolled in Medicare from 2010 to 2011. We examined the relationship between regional supply of chiropractic care and PCP services using Spearman correlation. Generalized linear models were used to examine the association between regional supply of chiropractic care and number of annual visits to PCPs for back and/or neck pain. We found a positive association between regional supply of chiropractic care and PCP services (rs = 0.52; P <.001). An inverse association between supply of chiropractic care and the number of annual visits to PCPs for back and/or neck pain was apparent. The number of PCP visits for back and/or neck pain was 8% lower (rate ratio, 0.92; 95% confidence interval, 0.91-0.92) in the quintile with the highest supply of chiropractic care compared to the lowest quintile. We estimate chiropractic care is associated with a reduction of 0.37 million visits to PCPs nationally, at a cost of $83.5 million. Greater availability of chiropractic care in some areas may be offsetting PCP services for back and/or neck pain among older adults. © Copyright 2015 by the American Board of Family Medicine.
... Insurance coverage is relatively limited yet. Federal healthcare schemes do not cover acupuncture and less than a quarter of state Medicaid programs cover acupuncture [63]. Eleven states have private insurance mandates [64]. ...
Article
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Complementary and alternative medicine (CAM), such as acupuncture and herbal medicine, is popular in many countries. Yet, treatment outcomes of CAM are found to vary significantly between medical trials in different social environments. This paper addresses how the social organization of medicine affects medical treatment outcomes. In particular, it examines the extent to which two popular complementary and alternative medicine (CAM) interventions (acupuncture and herbal medicine) are coordinated with biomedicine and how coordination characteristics are related to the treatment outcomes of the two CAM interventions. This paper conducts an archival analysis of the institutional settings of the CAM interventions in Japan and the U.S. It also conducts a systematic content analysis of the treatment outcomes in 246 acupuncture reports and 528 herbal medicine reports that are conducted in Japan or the U.S. and registered in the Cochrane Library's Central Register of Controlled Trials (CENTRAL), and 716 acupuncture reports and 3,485 herbal medicine reports that are from Japan or the U.S. and listed in MEDLINE. It examines the association between the treatment outcomes of the two interventions and the geographical location of the reports; it also explores how the institutional settings of the interventions are related to the treatment outcomes. Japanese herbal medicine is integrated into the national medical system the most and American herbal medicine the least; American acupuncture and Japanese acupuncture fall in the middle. Treatment outcomes are the most favorable for Japanese herbal medicine and the least favorable for American herbal medicine. The outcomes of American acupuncture and Japanese acupuncture fall in the middle. The co-utilization of CAM with biomedicine can produce difficulties due to tensions between CAM and biomedicine. These difficulties and subsequent CAM treatment outcomes vary, depending on how CAM is institutionalized in relation to biomedicine in the national medical system. Coordinated CAM interventions are more likely to be effective and synergic with biomedicine, when compared to uncoordinated ones.
... This may suggest that some Medicaid plans are unlikely to reimburse for art therapy, or that barriers exist for centers attempting to claim reimbursement. While some CAM therapies have become increasingly covered under state Medicaid formularies (Steyer, Freed, & Lantz, 2002), the national coverage of art and music therapy is understudied. ...
Article
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Although the implementation of evidence-based practices in the treatment of substance use disorders has attracted substantial research attention, little consideration has been given to parallel implementation of complementary and alternative medical (CAM) practices. Using data from a nationally representative sample (N = 299) of U.S. substance abuse treatment programs, this study modeled organizational factors falling in the domains of patient characteristics, treatment ideologies, and structural characteristics, associated with the use of art therapy and music therapy. We found that 36.8% of treatment programs offered art therapy and 14.7% of programs offered music therapy. Programs with a greater proportion of women were more likely to use both therapies, and programs with larger proportions of adolescents were more likely to offer music therapy. In terms of other treatment ideologies, programs' use of Motivational Enhancement Therapy was positively related to offering art therapy, whereas use of contingency management was positively associated with offering music therapy. Finally, our findings showed a significant relationship between requiring 12-step meetings and the use of both art therapy and music therapy. With increasing use of CAM in a diverse range of medical settings and recent federal legislation likely to reduce barriers in accessing CAM, the inclusion of CAM in addiction treatment is growing in importance. Our findings suggest treatment programs may be utilizing art and music therapies to address unique patient needs of women and adolescents.
... In our study, the highest percentage of participants using T&CM was recorded among the age group of 20-25 years. This is in agreement with the results of some studies in USA [17,[21][22], while Miller [23], Adams et al. [24], and Al-Faris et al. [14] have shown that T&CM use increased with age. ...
... [h1]Health Insurance Coverage for CAM Health insurance coverage for CAM varies across states due to differences in the regulation of CAM professions and insurance plans. Although most private and public insurance plans offer some CAM coverage (most often chiropractic manipulation), this usually includes limitations on services covered for specific conditions as well as the number of visits (Pelletier and Astin 2002;Steyer et al. 2002). ...
Article
Chronic conditions associated with lifestyle and modifiable behaviors are the leading causes of morbidity and mortality in the United States. The implementation of the Affordable Care Act offers an historic opportunity to consider novel approaches to addressing the nation's public health concerns. We adopt an anticipatory anthropological perspective to consider lifestyle behavior change as common ground shared by practitioners of both biomedicine and common forms of complementary and alternative medicine (CAM). At issue is whether CAM practitioners might play a more proactive and publicly endorsed role in delivering preventive and promotive health services to address these needs. Recognizing that this is a contentious issue, we consider two constructive roles for engaged medical anthropologists: (1) as culture brokers helping to facilitate interprofessional communities of preventive and promotive health practice and (2) in collaboration with health service researchers developing patient-near evaluations of preventive and promotive health services on patient well-being and behavior change.This article is protected by copyright. All rights reserved.
... Medicaid programs provide coverage for at least 1 alternative therapy, 50 most commonly chiropractic care (reimbursed by 33 programs), biofeedback (reimbursed by 10 programs), acupuncture (reimbursed by 7 programs), and hypnotherapy and naturopathy (reimbursed by 5 programs each). 50 Because state Medicaid benefits packages change frequently, pediatricians are encouraged to become familiar with their state's list of covered services. Some states require coverage for CAM services. ...
... Estados Unidos constituye un claro ejemplo de diversidad legislativa, donde las diferentes jurisdicciones de sus estados miembros difieren acerca de qué tipo de terapias deben ser reconocidas y/o prestadas por el servicio sanitario gubernamental o bien deben ser financiadas por el Estado. En la actualidad, se alzan voces que defienden la necesidad de una única legislación para ofrecer tratamientos eficaces y útiles a los usuarios, por un lado, y optimizar las investigaciones generadas por los proveedores, por el otro 13 . Todos los productos terapéuticos, los complementos alimenticios y los productos a base de plantas medicinales son de libre mercado. ...
... 3 Several factors may explain the variability seen in the use of CAM therapies over time. Such factors may include state licensure and availability of CAM practitioners 6,7 ; increased health insurance coverage of visits to CAM practitioners and specific CAM therapies 6,[8][9][10] ; inclusion of CAM in medical school curriculums [11][12][13] ; and integration of CAM practitioners and therapies into the practice of conventional medicine. [14][15][16] In addition, as the safety and efficacy of specific CAM therapies are validated by scientific studies, subsequent integration into clinical guidelines may increase their use. ...
Article
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Objectives: This study examined changes in the use of complementary and alternative medicine (CAM) therapies by U.S. adults aged 18 years or older with chronic disease-related functional limitations between 2002 and 2007. Design: The study was a cross-sectional survey. Setting/location: The study was conducted in the United States. Subjects: The study comprised adults aged 18 years or older with chronic disease-related functional limitations. Methods: Data were obtained from the 2002 and 2007 U.S. National Health Interview Survey to compare the use of 22 CAM therapies (n=9313 and n=7014, respectively). Estimates were age adjusted to the year 2000 U.S. standard population. Results: The unadjusted and age-standardized prevalence of overall CAM use (22 therapies comparable between both survey years) was higher in 2007 than in 2002 (30.6% versus 26.9%, p<0.001 and 34.4% versus 30.6%, p<0.001, respectively). Adults with functional limitations that included changing and maintaining body position experienced a significant increase in CAM use between 2002 and 2007 (31.1%-35.0%, p<0.01). The use of deep breathing exercises was the most prevalent CAM therapy in both 2002 and 2007 and increased significantly during this period (from 17.9% to 19.9%, p<0.05). The use of meditation, massage, and yoga also increased significantly from 2002 and 2007 (11.0%-13.5%, p<0.01; 7.0%-10.9%, p<0.0001; and 5.1% to 6.6%, p<0.05, respectively), while the use of the Atkins diet decreased (2.2%- 1.4%, p<0.01). Conclusions: Among U.S. adults with chronic disease-related functional limitations, the overall increase in CAM use from 2002 to 2007 was significant, particularly among those with changing and maintaining body position limitations.
... For example, of all the separate Medicaid programs across the United States and its territories, nearly 74 percent of Medicaid programs cover chiropractic whereas about 10 percent cover naturopathy. 25 CAM coverage by private insurers is based largely on market forces such as consumer demand and the perception of cost savings. 26 Compared to market forces, clinical effi cacy seems a relatively unimportant reason why insurers chose to offer CAM practices, even though most of the therapies covered have some degree of scientifi c backing, such as chiropractic, osteopathy, and acupuncture. ...
Article
The central issue in the current health care reform is cost. No health care reform can be successful without putting a rein on cost while maintaining a high quality of health care service. We believe one approach to solving the cost and quality issue is to allow patients the option to choose resources that are currently underutilized. Traditional health insurance plans offer consumers limited choice in that coverage is often denied when patients choose complementary and alternative medicine (CAM) treatments, even though the economic and social cost of treating certain conditions with alternative medicine may be more favorable than with conventional medicine. This article proposes a Dual Choice health insurance plan that would cover the cost of alternative medicines for certain medical conditions in the first stage. Should the alternative treatment turn out to be less effective, patients have the option to switch to conventional treatment in the second stage. Not only does this policy provide patients with more choices than in traditional plans, it will also likely provide significant cost savings while taking into account uncertainty regarding the effectiveness of CAM. By virtue of the wider choice offered to patients and lower cost, which is illustrated by a 2x2 effectiveness matrix, the authors think that insurance companies will be successful offering such an innovative insurance plan and will even out-compete companies offering only traditional plans. Furthermore, there will be substantial benefits that go beyond the cost savings. With both cost savings and patient welfare being central in the health care reform being proposed by the Obama administration, the dual choice plan offers considerable benefits.
... Estados Unidos constituye un claro ejemplo de diversidad legislativa, donde las diferentes jurisdicciones de sus estados miembros difieren acerca de qué tipo de terapias deben ser reconocidas y/o prestadas por el servicio sanitario gubernamental o bien deben ser financiadas por el Estado. En la actualidad, se alzan voces que defienden la necesidad de una única legislación para ofrecer tratamientos eficaces y útiles a los usuarios, por un lado, y optimizar las investigaciones generadas por los proveedores, por el otro 13 . Todos los productos terapéuticos, los complementos alimenticios y los productos a base de plantas medicinales son de libre mercado. ...
... Medicaid programs provide coverage for at least 1 alternative therapy, 50 most commonly chiropractic care (reimbursed by 33 programs), biofeedback (reimbursed by 10 programs), acupuncture (reimbursed by 7 programs), and hypnotherapy and naturopathy (reimbursed by 5 programs each). 50 Because state Medicaid benefits packages change frequently, pediatricians are encouraged to become familiar with their state's list of covered services. Some states require coverage for CAM services. ...
Article
The American Academy of Pediatrics is dedicated to optimizing the well-being of children and advancing family-centered health care. Related to these goals, the American Academy of Pediatrics recognizes the increasing use of complementary and alternative medicine in children and, as a result, the need to provide information and support for pediatricians. From 2000 to 2002, the American Academy of Pediatrics convened and charged the Task Force on Complementary and Alternative Medicine to address issues related to the use of complementary and alternative medicine in children and to develop resources to educate physicians, patients, and families. One of these resources is this report describing complementary and alternative medicine services, current levels of utilization and financial expenditures, and associated legal and ethical considerations. The subject of complementary and alternative medicine is large and diverse, and consequently, an in-depth discussion of each method of complementary and alternative medicine is beyond the scope of this report. Instead, this report will define terms; describe epidemiology; outline common types of complementary and alternative medicine therapies; review medicolegal, ethical, and research implications; review education and training for complementary and alternative medicine providers; provide resources for learning more about complementary and alternative medicine; and suggest communication strategies to use when discussing complementary and alternative medicine with patients and families.
... This is quite possible since health insurance coverage frequently excludes many CAM interventions. This may change if private and government-funded insurance plans begin to adopt broader coverage plans for CAM modalities (Pelletier & Astin, 2002;Steyer, Freed, & Lantz, 2002). CAMrelated expenses have grown considerably over the past decade and will certainly become a major public health issue in the future MacLennan, Wilson, & Taylor, 2002;Thomas, Nicholl, & Coleman, 2001). ...
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The correlates of complementary and alternative medicine (CAM) utilization among elders have not been fully investigated. This study was designed to identify such correlates in a large sample of older adults, thus generating new data relevant to consumer education, medical training, and health practice and policy. A subsample from the 2000 Wave of the Health and Retirement Study (n = 1,099) aged 52 or older were surveyed regarding use of CAM (chiropractic, alternative practitioners, dietary and herbal supplements, and personal practices). Of respondents over 65 years of age, 88% used CAM, with dietary supplements and chiropractic most commonly reported (65% and 46%, respectively). Users of alternate practitioners and dietary supplements reported having more out-of-pocket expenses on health than nonusers of these modalities. Age correlated positively with use of dietary supplements and personal practices and inversely with alternative practitioner use. Men reported less CAM use than women, except for chiropractic and personal practices. Blacks and Hispanics used fewer dietary supplements and less chiropractic, but they reported more personal practices than Whites. Advanced education correlated with fewer chiropractic visits and more dietary and herbal supplement and personal practices use. Higher income, functional impairment, alcohol use, and frequent physician visits correlated with more alternative practitioner use. There was no association between CAM and number of chronic diseases. The magnitude and patterns of CAM use among elders lend considerable importance to this field in public health policy making and suggest a need for further epidemiological research and ongoing awareness efforts for both patients and providers.
... Economic and regulatory factors can have a tremendous role in the usage rates of specific treatments or technologies (74). Even consumer demand can shape practice patterns, as evidenced by the increased rate of third-party reimbursement for complementary and alternative therapies (75). These factors notwithstanding, there are a number of ways in which medicine as a field can act to improve concordance between evidence and clinical practice. ...
Article
Billions of dollars are spent every year to support medical research, with a substantial percentage coming from charitable foundations. To justify these expenditures, some measure of the return on investment would be useful, particularly one aligned with the intended ultimate outcome of this scientific effort: the amelioration of disease. The current mode of reporting on the success of medical research is output based, with an emphasis on measurable productivity. This approach falls short in many respects and may be contributing to the well-described efficacy-effectiveness gap in clinical care. The author argues for an outcomes-based approach and describes the steps involved, using an adaptation of the logic model. A shift in focus to the outcomes of our work would provide our founders with clearer mission-central return-on-investment feedback, would make explicit the benefits of science to an increasingly skeptical public, and would serve as a compass to guide the scientific community in playing a more prominent role in reducing the efficacy-effectiveness gap. While acknowledging the enormous complexity involved with the implementation of this approach on a large scale, the author hopes that this essay will encourage some initial steps toward this aim and stimulate further discussion of this concept.
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This new edition of the Complete Nurse’s Guide to Diabetes Care is a comprehensive resource for all nurses who work with diabetes patients. Inside, readers will find expert advice on: The Complete Nurse’s Guide to Diabetes Care, 3rd Edition, gives nurses the tools they need to give quality care to the person with diabetes.
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Background Increasing access to non-pharmacologic pain management modalities, including acupuncture, has the potential to reduce opioid overuse. A lack of insurance coverage for acupuncture could present a barrier for both patients and providers. The objective of this scoping review was to assess the existing literature on acupuncture insurance coverage in the United States and to identify knowledge gaps and research priorities. Methods We utilized the Arksey and O’Malley framework to guide our scoping review methodology. We followed a pre-determined study protocol for the level-one abstract and level-two full text screenings. We synthesized information into subject-area domains and identified knowledge gaps. Results We found a lack of published data on acupuncture coverage in 44 states, especially in the Midwest and the South. Where data were available, a large proportion of acupuncture users did not have insurance coverage. Consumer demand, state mandates, and efforts to reduce opioid use were motivations to cover acupuncture. Licensed acupuncturists were less likely to be reimbursed and were reimbursed at lower rates compared to physicians. Reported barriers encountered when implementing coverage included a lack of providers, challenges determining when to offer non-pharmacologic treatments, and a lack of evidence for clinical efficacy and cost-effectiveness. Conclusion We found a lack of recent publications and data comparing regional coverage in the United States. A key challenge is that commercial insurance plan data are not in the public domain. Further research should assess insurance coverage implementation for acupuncture and measure the impact of policy changes on acupuncture utilization and rates of opioid overuse.
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Complementary and alternative medicine (CAM) is often considered one part of a bimodal health care system in many Asian countries. As a result of emigrating populations into the United States, visibility and usage of CAM has increased in Asian American communities and has become more accepted in the general US population. Although tension exists in incorporating CAM therapies into Western medical practice, the integration of practices is now becoming more accepted and even utilized by mainstream groups. This chapter will discuss the components of CAM and integrative medicine, the philosophies behind both approaches, use of CAM in Asian Americans, challenges in integrating the use of CAM, and policy initiatives.
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Paediatric use of complementary and alternative medicine is common and increasing, particularly for the sickest children. This review discusses the various options available including dietary supplements, hypnosis, massage, chiropractic, and acupuncture.
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Complementary and alternative medicine services in the United States are an approximately $9 billion market each year, equal to 3 percent of national ambulatory health care expenditures. Unlike conventional allopathic health care, complementary and alternative medicine is primarily paid for out of pocket, although some services are covered by most health insurance. Examining trends in demand for complementary and alternative medicine services in the United States reported in the Medical Expenditure Panel Survey during 2002-08, we found that use of and spending on these services, previously on the rise, have largely plateaued. The higher proportion of out-of-pocket responsibility for payment for services may explain the lack of growth. Our findings suggest that any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best. Should some forms of complementary and alternative medicine-for example, chiropractic care for back pain-be proven more efficient than allopathic and specialty medicine, the inclusion of complementary and alternative medicine providers in new delivery systems such as accountable care organizations could help slow growth in national health care spending.
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