The Selection Effects of the Inclusion of a Chiropractic Benefit on the Patient Population of a Managed Health Care Organization
Received 6 May 2004; received in revised form 21 July 2004
Objective
The aim of this study is to measure the selection effects of the inclusion of a chiropractic benefit on a managed care health plan.
Design
An analysis of enrollment data from a managed care health plan over a 4-year period was conducted. Employers could select the managed care plan with or without a chiropractic care benefit. Comparisons of demographic and comorbid characteristics were made between employees who had the chiropractic benefit and those who did not, and between individuals who self-selected chiropractic care and those who self-selected medical care.
Results
The cohort with chiropractic coverage was younger with fewer subjects in the older age group (>65 years; 6.5% vs 9.6%) and more subjects in the younger age group (0-17 years; 31.9% vs 26.2%). The mean age of the group with coverage was 32.9 compared with 35.5 in the group without coverage. Comparing self-selected chiropractic patients to self-selected medical patients, there were fewer subjects older than 65 years in the chiropractic group (4.9% vs 9.2%) and fewer subjects aged 0 to 17 years (9.4% vs 19.4%). In 6 of the 8 comorbid conditions studied, the rates were lower in the cohort with chiropractic coverage compared with the group without coverage. The rates of comorbid conditions in self-selected chiropractic patients were lower in all 8 categories compared with self-selected medical patients.
Conclusion
The inclusion of a chiropractic benefit in a health plan produces a modest favorable selection processes resulting in a slightly younger patient population with fewer comorbidities. At the level of patient self-selection, chiropractic patients are considerably younger and healthier than comparable medical patients.
aDirector of Research, American Specialty Health, San Diego, Calif
bChief Health Services Officer, American Specialty Health, San Diego, Calif
cVice President for Clinical Services, American Specialty Health, San Diego, Calif
dDirector, Corporate Health Improvement Program (CHIP); Clinical Professor of Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Md, and University of Arizona School of Medicine, Tucson, Ariz
Submit requests for reprints to: Craig Nelson, DC, MS, American Specialty Health, 777 Front Street, San Diego, CA 92101.
Sources of support: American Specialty Health funded this project.
ABSTRACT