Cost Effectiveness


Chiropractic and Health Care Reform: A Proven Value Based on Cost-effective, Clinically-effective, Preventive and Wellness Care

For a print-friendly version of this article, click here

Health care reform is a top priority this year for California lawmakers, with the stated goal of making health insurance more affordable and accessible for all. To achieve these goals, any successful reform proposal must allow direct access to cost-effective and preventive care, both areas in which doctors of chiropractic have a proven record of success.

The conditions doctors of chiropractic treat are among the most prevalent for which people seek care.  Consider these facts:

  • Back pain is the second leading cause for physician visits.
  • Back pain is second only to childbirth for hospitalizations.
  • Back pain is the most prevalent chronic medical condition.
  • Back pain is the number one cause of long-term disability.

Chiropractic is a proven value.

Chiropractic coverage is included by cost-conscious programs such as Medicare, workers’ compensation, Healthy Families and the Veterans Administration system, as well as most group health plans.  Independent, peer-reviewed studies have shown that health plans that include chiropractic care have lower overall costs than those that do not.  Research has found that adding chiropractic care to a health plan in California does not result in an increase in cost.  Rather, patients use chiropractic care as a direct, typically less expensive, substitute for care provided by a medical doctor.

Chiropractic doctors are primary care doctors focused on prevention and wellness.

Doctors of chiropractic are trained and licensed to serve as primary care doctors, and treat patients without the use of potentially dangerous drugs or expensive surgeries.  Doctors of chiropractic are trained in a holistic approach to treatment that focuses on prevention, wellness care, dietary and nutritional counseling, exercise, rehabilitation and ergonomics.

Patient choice and direct access are key to cost-effectiveness and positive health outcomes.

Positive health and financial outcomes occur when patients have direct access to the care that is most appropriate for their condition.  Both patient choice of provider and direct access to that provider are important elements to ensure that patients get the care they need when they need it.

Studies show cost-effectiveness and health benefits of chiropractic care.

Volumes of independent studies provide conclusive evidence that chiropractic care leads to better health outcomes, higher patient satisfaction with their care and lower costs when compared to traditional health care providers.  The following is a summary of studies on the subject:

  • A study explored the relationship between prescribed opioids and disability among patients consulting in primary care with back pain. The findings indicate that even after adjusting for a substantial number of potential confounders, opioids were significantly associated with higher disability and with slightly worse functioning in back pain patients at a 6 month follow–up. Source: Pain April 2013
  • Reduced odds of surgery were observed for injured workers whose first provider was a doctor of chiropractic.  In a study of injured workers 42.7 percent who first saw a surgeon had surgery in contrast to only 1.5 percent of those who first saw a doctor of chiropractic. Source: Spine, December 2012.
  • The cost of care for common back pain conditions was significantly less when care was initiated with a doctor of chiropractic versus a medical doctor or osteopath.  A study by Blue Cross Blue Shield of Tennessee demonstrated a 40 percent cost savings for low back pain treatment initiated by a doctor or chiropractic when compared with care initiated through a medical doctor.  Source: Journal of Manipulative and Physiological Therapeutics, 2010.
  • Treatment provided by doctors of chiropractic for neck and low back pain improves the value of health benefit plans.  A report by Arnold Milstein, MD, MPH of Mercer Health Benefits and Niteesh Choudhry, MD, PhD of Harvard Medical School found that when considering effectiveness and cost together, care for low back and neck pain by a doctor of chiropractic is highly cost effective and represents a good value in comparison to medical physician care.  Source:  Mercer Health and Benefits, 2009.
  • Chiropractic care is not an add-on but rather it is a direct substitution for other types of treatment.  A study of corporate medical plans found that patients use chiropractic treatment as a direct substitution for medical care.  It also demonstrated that having a chiropractic benefit rider did not increase the number of patients seeking treatment for neuromusculoskeletal complaints.  Source:  Journal of Occupational and Environmental Medicine, 2004
  • A health insurance plan with a chiropractic benefit had lower costs than a plan without it.  A study reported in the American Medical Association’s journal found health plans that included a chiropractic benefit had 31 percent fewer back surgeries and 15 percent lower per capita hospital costs. The study compared 700,000 health plan members with chiropractic benefits to 1 million members without chiropractic benefits in California, and showed that overall health care expenditures were lower in the group with chiropractic coverage.  Source:  Archives of Internal Medicine, October 2004.
  • Doctors of chiropractic serving as primary care physicians led to better clinical and cost outcomes.  When doctors of chiropractic served as primary care physicians in an Illinois health maintenance organization (HMO), the results were substantially improved clinical and cost outcomes when compared to medical doctor care. The doctors of chiropractic, who emphasized preventive and wellness care, showed a 43 percent reduction in patient hospital admissions, a 58 percent reduction in hospital days, a 43 percent reduction in outpatient surgeries and procedures, and a 51 percent reduction in pharmaceutical costs.  The study spanned four years and included 21,743 patient months.  Source:  Journal of Manipulative and Physiologic Therapeutics, June 2004.
  • Immediate access to chiropractic care after an injury results in the most effective outcome, medically and financially.  A peer-reviewed article in the Journal of Occupational and Environmental Medicine, January 2004, stated: “. . . We found that patients who were seen by chiropractors during the initial episode of care were less likely to have a surgery, and had a shorter average duration of the initial episode.” 


The practice of chiropractic focuses on the relationship between the structure and function of the body and how that relationship affects the preservation and restoration of health.  Treatment approaches used by doctors of chiropractic include joint manipulation and spinal adjustments, and a host of preventive and wellness care regimens.  Doctors of chiropractic focus on cost-saving care that returns patients to normal function.

In today’s broken health care system, conventional health care providers treat illness.  By contrast, chiropractic doctors specialize in keeping people well by emphasizing prevention and wellness, and avoiding prescription drugs and surgery.  Any health care reform program should rely on direct access to chiropractic doctors to achieve the most positive health and successful financial results.