Chiropractic - Utilization, Satisfaction Rates, and Third-party Coverage

Utilization, Satisfaction Rates, and Third-party Coverage

In the U.S., chiropractic is the largest alternative medical profession, and is the third largest doctored profession, behind medicine and dentistry. In the U.S., chiropractors perform over 90% of all manipulative treatments. The percentage of the population that utilizes chiropractic care at any given time generally falls into a range from 6% to 12% in the U.S. and Canada, with a global high of 20% in Alberta.

Chiropractors are the most common CAM providers for children and adolescents, who consume up to 14% of all visits to chiropractors. The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints; most do so specifically for low back pain. Practitioners such as chiropractors are often used as a complementary form of care to primary medical intervention.

Satisfaction rates are typically high for treatment of low back pain, with a 1998 U.S. survey reporting 83% of respondents satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors. A 2011 consumer report survey found that the public considered chiropractic to outperform all other available back and neck pain treatments.

Chiropractic does not have the same level of mainstream credibility as other healthcare professions. Public perception of chiropractic compares unfavorably with mainstream medicine with regard to ethics and honesty: in a 2006 Gallup Poll of U.S. adults, chiropractors rated last among seven health care professions for being very high or high in honesty and ethical standards, with 36% of poll respondents rating chiropractors very high or high; the corresponding ratings for the other professions ranged from 62% for dentists to 84% for nurses.

The 2008 book Trick or Treatment states chiropractors, especially in America, have a reputation for unnecessarily treating patients, and in many circumstances the focus seems to be put on economics instead of health care. Many chiropractors have sought to address their minor status within the U.S. medical community by attending practice-building seminars to assist chiropractors to persuade their patients of the efficacy of their treatments, increase their revenue, and boost their morale as unorthodox medical practitioners. Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations.

The largest chiropractic associations in the U.S. and Canada distributed patient brochures which contained unsubstantiated claims. Sustained chiropractic care is promoted as a preventative tool, but unnecessary manipulation could present a risk to patients. Some chiropractors are concerned by the routine unjustified claims chiropractors have made. A 2010 questionnaire presented to UK chiropractors indicated only 45% of chiropractors disclosed with patients the serious risk associated with manipulation of the cervical spine as a direct consequence of the fear that the patient would refuse treatment despite knowing the moral responsibility.

Utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient. The use of chiropractic declined from 9.9% of U.S. adults in 1997 to 7.4% in 2002; this was the largest relative decrease among CAM professions, which overall had a stable use rate. As of 2007 only 7% of the U.S. population is being reached by chiropractic. Employment of U.S. chiropractors is expected to increase 14% between 2006 and 2016, faster than the average for all occupations.

In the U.S., most states require insurers to cover chiropractic care, and most HMOs cover these services. In Canada, there is lack of coverage under the universal public health insurance system. In Australia, most private health insurance funds cover chiropractic care, and the federal government funds chiropractic care when the patient is referred by a medical practitioner.