How to Save Billions of Dollars
[originally published in KCN, August 1998]
Our neighbors to the north have recently been shown a way to save millions, if not billions, of dollars each year on their health care, thanks to a comprehensive report presented earlier this year by Canadian health economist Pran Manga, PhD.
First, a little background. Dr. Manga, a professor of health economics at the University of Ottawa, is known by most in the health care industry for his 1993 landmark report on “The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain.” This report was funded by the Ontario Ministry of Health to aid them in their efforts to contain and reduce health care costs in their province. After an exhaustive review of the scientific literature, Dr. Manga and his colleagues found that spinal adjustments given by chiropractors were more effective than other forms of treatment for low back pain. In fact, they reported that, “…many medical therapies were of questionable validity or were clearly inadequate.” They also found chiropractic care to be safer than medical management of low back pain, and that, “…an overwhelming body of evidence indicated that chiropractic management of low back pain was more cost-effective than medical management.” In their recommendations to the government for reform, they stated that ,“…chiropractic services should be fully insured under the Ontario Health Insurance Plan.” They went on to say that this one step could, “…be expected to lead to very significant savings in health care expenditure.”
Flash ahead to 1998. As the Ontario Ministry of Health continues to tinker with reforming their health care system, they are realizing that their traditional “knee-jerk reflex” of “institutional and hospital care” is not always in the patient’s best interest nor their’s. Consequently, a shift from the previously unquestioned status quo is taking place, and officials are out to find “the right care from the right provider at the right time” [and at the right price, I might add]. Wanting to stay in the forefront of the minds of the Ontarian government during this time of change, the Ontario Chiropractic Association (OCA) has kept an ongoing dialogue with the powers that be. Consequently, the OCA commissioned Dr. Manga to update his 1993 study — this time to encompass all neuromusculoskeletal conditions [any condition dealing with nerves, muscles, and bones — I’ll refer to them as NMS from now on] instead of just low back pain, and to develop an economic model and an estimate of specific cost-savings. This latest analysis entitled “Enhanced Chiropractic Coverage Under the Ontario Health Insurance Plan as a Means of Reducing Health Care Costs, Attaining Better Health Outcomes, and Achieving Equitable Access to Health Services,” was presented to Ontario’s Committee of Finance and Economic Affairs in February for their consideration for the 1998-99 budget.
Currently under the Ontario Health Insurance Plan, all medical care is free. Chiropractic care, on the other hand, requires a substantial copayment on the part of the patient and consequently represents a major barrier of access for most Ontarians. So it is not surprising, that under this system, the poor and lower-middle income groups and the elderly are low users of chiropractic. Ironically, these very groups of people are probably the ones who could benefit the most from chiropractic care, as the prevalence of NMS conditions is the highest among these socioeconomic groups.
With medical care being “free”, it is also not surprising that an overwhelming majority of patients with NMS conditions and injuries visit medical doctors first. Most Canadian chiropractic patients (81%) have had back pain or other NMS conditions for 6 months prior to their seeking the care of a chiropractor — most of them having already had extensive medical/physical therapy.
Dr. Manga’s report impressively demonstrates that by increasing the public’s utilization of chiropractic services for NMS conditions from 10% to 20%, through the sharp reduction or elimination of patient copayment amounts, the Ontarian Government will see a direct savings of at least $380 to $770 million per year. The resulting decreases in short and long-term disability will allow the government and private sector to realize an additional indirect savings of $1.255 to $3.775 billion.
That’s a pretty big chunk of change for doing something as simple as rerouting the traditional health care flow for NMS conditions. In his report, Dr. Manga takes some bold stances stating that, “There is no reason to perpetuate the existing perverse situation in which cost-effective and safer services are subject to a copayment which inhibits access to them, whereas care which is less effective and safe and more costly is offered free of any copayments.” He later goes on to say that with publicly supported health insurance, ultimately this situation, “…results in a higher tax burden on the public to cover the less cost-effective medial management ….” According to Dr. Manga, “Insurance companies are now asking the question that should have been addressed many decades ago: which caregiver is most cost-effective in managing an episode of a specific problem?… [Traditionally] our insurance plans presuppose just one type of gatekeeper and caregiver, and relegate all others as subservient, subordinate, or complementary to the medical profession.” Dr. Manga sums up his thoughts by stating, “The evidence is that chiropractic services should be frontline services for many NMS disorders rather than the default system of care when all else fails, as it seems to be for many patients.”
Maybe we could learn a thing or two from our friends up north. Naa. Our health care system is just fine, thank you — ask Hillary.