Friday, January 25, 2013

Who is to Blame for Spine Care Costs in the US ?

Who is to Blame for Spine Care Costs in the US ?

Where the United States Spends Its Spine Dollars: Expenditures on Different Ambulatory Services for the Management of Back and Neck Conditions. Spine: 01 September 2012 - Volume 37 - Issue 19 - p 1693–1701. Davis, Matthew A. DC, MPH; Onega, Tracy PhD; Weeks, William B. MD, MBA; Lurie, Jon D. MD, MS.


Back and neck conditions are associated with considerable costs to the US economy both due to direct expenditures on their management and 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.
  • Back pain is the second most common reason adults consult a primary care provider, following upper respiratory tract infections.
In recent years, prevalence and costs for spinal conditions has significantly increased in the United States despite the little change in outcomes for these individuals suffering from these conditions. It is estimated 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.

Therefore the purpose of this study was to examine the US expenditures (costs) on common ambulatory health services for the management of back and neck conditions (spine conditions) for:
  • Medical Care.
  • Chiropractic Care.
  • Physical Therapy. 
Study Design:

A Medical Expenditure Panel Survey (MEPS) from 1999 - 2008 was utilized. Data from US adults 18+ was used with sample sizes for the MEPS during these years ranging from a low of 23,565 individuals in 1999 to a high of 37,418 individuals in 2002; response rates ranged from 56.9% in 2007 to 66.3% in 2001.

Results of the Study:

In 1999, 11.9 million adults had an ambulatory visit for a primary diagnosis of a spine condition. This number increased approximately 15% during the study period to 13.6 million in 2008; however, with population growth, the proportion of all US adults reporting a visit for a primary diagnosis of a spine condition remained constant at approximately 6%. 

Number of visits per specialty:

Medical Care: The mean number of ambulatory visits to medical physicians for a primary diagnosis of a spine condition fluctuated between approximately 2.9 and 3.7 visits per year from 1999 to 2008.

Chiropractic Care: The mean number of visits for chiropractic care fluctuated between 7.2 and 9.3 visits per year.

Physical Therapy: There was more variability among adults utilizing Physical Therapy, the mean number of visits per year ranging between a high of 11.4 in 2002 to a low of 6.8 in 2005.

Annual Expenditures / Costs per Specialty:

Medical Care: The mean inflation-adjusted expenditure increased by 95% (from $487 in 1999 to $950 in 2008). The Mean specialist care costs ranged from approximately $800 in 1999 to more than $1,200 by 2008.

Chiropractic Care: The mean expenditure varied much less, fluctuating between a low of $473 in 1999 and a high of $662 in 2007.

Physical Therapy: The annual inflation-adjusted mean expenditure per user on physical therapy peaked in 2002 at $1543 and apparently contracted thereafter; however, the confidence intervals for physical therapy were large, implying considerable variation in expenditures among physical therapy users.


According to our estimates, the total annual expenditures on medical care for the management of spine conditions has grown significantly in recent years, whereas expenditures on chiropractic care and physical therapy have not experienced the same growth. Our study suggests that this growth in medical care is primarily due to increases in expenditures on Specialty care services (expenditures on primary care physician services were remarkably stable during the 10 years we examined).  Specialty care services include: Orthopedists / Orthopedic Surgery, Physiatry / Physical Medicine & Rehabilitation, Neurology and Neurosurgery.

Dr. Rommel Hindocha D.C. is the clinic director at Peninsula Spine & Sports Rehabilitation, located in San Mateo, California. Dr. Hindocha also practices at San Francisco Multi-Specialty Medical Group in San Francisco where he enjoys working with his Medical Specialist counterparts. In his San Mateo practice, Dr. Hindocha specializes in chronic back and neck pain, including: Sciatica, Hernaited Discs, Spinal Arthritis, Degenerative Disk Disease and Spinal Stenosis.

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