Where the United States Spends Its Spine Dollars Expenditures on Different Ambulatory Services for the Management of Back and Neck Conditions

The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03766, USA.
Spine (Impact Factor: 2.3). 03/2012; 37(19):1693-701. DOI: 10.1097/BRS.0b013e3182541f45
Source: PubMed


Serial, cross-sectional, nationally representative surveys of noninstitutionalized US adults.
To examine expenditures on common ambulatory health services for the management of back and neck conditions.
Although it is well recognized that national costs associated with back and neck conditions have grown considerably in recent years, little is known about the costs of care for specific ambulatory health services that are used to manage this population.
We used the Medical Expenditure Panel Survey to examine adult (aged 18 yr or older) respondents from 1999 to 2008 who sought ambulatory health services for the management of back and neck conditions. We used complex survey design methods to make national estimates of mean inflation-adjusted annual expenditures on medical care, chiropractic care, and physical therapy per user for back and neck conditions.
Approximately 6% of US adults reported an ambulatory visit for a primary diagnosis of a back or neck condition (13.6 million in 2008). Between 1999 and 2008, the mean inflation-adjusted annual expenditures on medical care for these patients increased by 95% (from $487 to $950); most of the increase was accounted for by increased costs for medical specialists, as opposed to primary care physicians. During the study period, the mean inflation-adjusted annual expenditures on chiropractic care were relatively stable; although physical therapy was the most costly service overall, in recent years those costs have contracted.
Although this study did not explore the relative effectiveness of different ambulatory services, recent increasing costs associated with providing medical care for back and neck conditions (particularly subspecialty care) are contributing to the growing economic burden of managing these conditions.

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    • "Disease 2010 study, the overall impact of neck pain 6 on death and disability accounts for one fifth of all 7 musculoskeletal diseases [2]. For those suffering from 8 back and neck conditions, the mean inflation-adjusted 9 annual expenditures on medical care has increased to 10 $950 in the United States [3]. Direct costs can be as-11 cribed to healthcare related contacts, medication use 12 and other socioeconomic costs (i.e. "
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    Full-text · Article · Oct 2014 · Journal of Back and Musculoskeletal Rehabilitation
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    • "Nevertheless, the effect of most conservative treatments is only small to moderate (Keller et al., 2007). In this context, referrals to secondary care of those with chronic and disabling symptoms are common and considered to be a significant contributor to the economic burden of LBP (Davis et al., 2012; Hong et al., 2013). The challenge of finding optimum treatment for LBP has shifted the attention to the identification of prognostic factors (Hayden et al., 2010). "
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    • "During the study period, the mean inflation-adjusted annual expenditures on chiropractic care were relatively stable. Physical therapy was the most costly service overall [7]. Spinal manipulation is used by doctors of chiropractic (DC), osteopathic physicians, and physical therapists to treat musculoskeletal disorders [8] [9] [10] [11] [12]. "
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