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

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SOURCE:   Spine 2012 (Sep 1); 37 (19): 1693–1701 ~ FULL TEXT

Matthew A. Davis, DC, MPH

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

STUDY DESIGN:   Serial, cross-sectional, nationally representative surveys of noninstitutionalized US 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 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.

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. 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.

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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.

Keywords:   Medical Expenditure Panel Survey (MEPS), Spine Expenditures, Back Pain, Neck Pain

From the FULL TEXT Article:


Back and neck conditions are associated with considerable costs to the US economy both due to direct expenditures on their management and to indirect costs from losses in productivity. Between 49% and 70% of all adults will experience a back pain episode during their lifetime, and, at any given point in time, 12% to 30% of adults have an active back problem. [1] Back pain is the second most common reason adults consult a primary care provider, following upper respiratory infections. [2, 3]   In recent years the prevalence and expenditures on spinal conditions in the US has increased significantly despite little change in the health status among people who suffer from these conditions. [4, 5]   Estimates of the total expenditures on care vary, but the general consensus is that approximately $90 billion is spent on the diagnosis and management of low back pain, and an additional $10 to $20 billion is attributed to economic losses in productivity each year. [4, 6, 7]   However, little is known about the pattern of expenditures for different health services that manage this population.

It is generally accepted that medical care per unit (i.e. either per procedure or per episode) has gotten more expensive. Less is known about the cost of other non-medical services, such as chiropractic care and physical therapy, that manage a large percentage of back and neck cases in the US. [8]   Examining expenditures on the various ambulatory health services for back and neck conditions, particularly over time, is essential for health policy makers. Such information offers insight into the effects of health policy decisions and informs future strategies in regards to cost-containment efforts. As future health policy decisions will entail consideration of the overall cost and effectiveness of spinal interventions to improve population health, it is important to have a better understanding of spending patterns on health services.

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