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Where the U.S. Spends its Spine Dollars

Where the U.S. Spends its Spine Dollars: Expenditures on Different Ambulatory Services for the Management of Back and Neck Conditions

The Chiro.Org Blog


SOURCE:   Spine (Phila Pa 1976). 2012 (Mar 16)

Davis, Matthew A. DC, MPH; Onega, Tracy PhD;
Weeks, William MD, MBA; Lurie, Jon MD, MS

The Dartmouth Institute for Health Policy and Clinical Practice,
Lebanon, NH 03766, USA


Study Design   Serial, cross-sectional, nationally representative surveys of non-institutionalized adults.

Objective   To examine expenditures on common ambulatory health services for the management of back and neck conditions.

Summary of Background Data   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.

Methods   We used the Medical Expenditure Panel Survey (MEPS) to examine adult (age ≥ 18 years) 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.

Results   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.
  • Over the study period, the mean inflation-adjusted annual expenditures on chiropractic care were relatively stable;
  • While physical therapy was the most costly service overall, in recent years those costs have contracted.
  • Conclusion   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.

    This is a tough pill to swallow, considering that a:

    Recent Study Reveals That Back Surgery Fails 74% of the Time

    and the fact that:

    Medical Graduates and Orthopedic Residents are Incompetent in Musculoskeletal Assessment


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    About the Author:

    I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.

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