More than half of all adults will experience back or neck pain at some point during their lifetime, and these health issues currently rank as the second most common reason for medical visits, trailing only upper respiratory infections. Recently, expenditures on spinal conditions in the United States have increased significantly despite few changes in the overall health status of people who experience these conditions. Estimates vary, but it is generally believed that about $90 billion is spent on the diagnosis and management of low back and neck pain each year. An additional $10 to $20 billion annually is attributed to economic losses in productivity.

“Little is known about the pattern of expenditures for different health services for managing patients with back and neck pain,” says Jon D. Lurie, MD, MS. “While it has been generally accepted that medical care costs per unit have become more expensive, few analyses have explored costs relating to other non-medical services, such as chiropractic care and physical therapy.”

A Deeper Review of Back & Neck Expenditures

It is important for health policy makers to examine expenditures on the different ambulatory health services for back and neck conditions, according to Dr. Lurie. “This information can provide insights into the effects of health policy decisions and inform future strategies for containing costs. A better understanding of spending patterns on health services is needed to gain a better picture of the overall cost and effectiveness of spinal interventions to improve health.”

Using data from the Calgary Chiropractic Doctors Association and the Medical Expenditure Panel Survey, Dr. Lurie and colleagues reviewed U.S. expenditures on common health services used for managing spine conditions in a study published in Spine. “Specifically, we looked at expenditures on medical care, chiropractic care, and physical therapy,” says Dr. Lurie. “These are the three most common ambulatory health services used by patients suffering from spine conditions.”

The study team analyzed data on how much Americans spent on ambulatory care for back and neck problems from 1999 to 2008. In 2008, about 6% of adults (13.6 million people) reported having an ambulatory visit for a primary diagnosis of a back or neck condition. “The percentage of patients who made ambulatory spinal care visits during the study period remained remarkably stable,” Dr. Lurie says (Table). “Furthermore, the health status of adults with a primary diagnosis of a spine condition has not improved despite increasing costs over time.”

Assessing the Spending Increase

After adjusting for inflation, the annual medical spending for spinal care per patient increased by 95% from 1999 to 2008, rising from $487 to $950 in 2008 dollars. “Most of this increase was accounted for by increased costs for care from medical specialists,” explains Dr. Lurie (see online exclusive Figure). “There was little or no change in spending for spinal care provided by primary care and family doctors, internists, or general practitioners.”
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The findings also demonstrated that the mean inflation- adjusted annual expenditures on chiropractic care were relatively stable over the 10-year study period. Physical therapy was the most costly service overall, but these costs varied over time, peaking in 2002 and contracting thereafter. “Considering these results,” Dr. Lurie says, “it appears that the recent increasing costs associated with providing medical care for back and neck conditions—particularly medical specialist care—are significant contributors to the growing economic burden of managing these conditions.”

An Impact on Health Policy Decisions

The data from the study by Dr. Lurie and colleagues are particularly important when considered in the context of examining the effects of health policy decisions that are aimed at controlling costs. “The decisions on reimbursement for health services in the management of spine conditions can have significant effects over time,” says Dr. Lurie. “For example, our analysis showed that costs for chiropractic care remained stable over a 10-year period. This trend is likely the result of health policy decisions to limit reimbursable practices for chiropractors. On the other hand, medical specialists rely more heavily on reimbursable advanced technologies. These are more likely to increase expenditures.”

It is critical to determine the relative effectiveness and cost-effectiveness of ambulatory health services and to establish if medical specialist care is truly necessary when managing back and neck conditions, Dr. Lurie says. “Strategies aimed at reducing dependency on specialty care may decrease national spending on spine conditions. National efforts to substitute specialist care physicians with primary care providers or other practitioners when appropriate may help us further contain costs for this important patient population.”