Insurance Coverage and Subsequent Utilization of Complementary and Alternative Medicine

“Insurance Coverage and Subsequent Utilization of Complementary and Alternative Medicine Providers” Lafferty et al. Univ. of Washington

This study, published in the Amer. Journal of Managed Care in July, is the largest study to date to report figures for population-based utilization and financial consequences to third-party payers for covering naturopathic physicians and other CAM providers.

-Univ. WA

-600,000 enrollees, 75% of Western Washington State’s private insurance market. -Three companies: BC, BS and Group Health. Actuarial claims data from 2002.

-There are 422 actively licensed N.D.s the state of WA: which is 1/3 of all NDs licensed nationally. One of the training centers: Bastyr University located here. If you are going to see high utilization and costs, you would see them in WA.

RESULTS:

-Visits to N.D.s constituted just 1% of all outpatient provider visits and accounted for 0.3% of the dollars paid out by insurers, for an average of $9 per enrollee.

-By far the highest usage in CAM was chiropractic, which accounted for 12% of all outpatient provider visits. When chiropractic, acupuncture, naturopathic medicine and massage therapy are all lumped together all CAM visits accounted for 17.6 % of outpatient provider visits, but just 2.9% of the total medical expenditures. (end pg. 399-400). The researchers continued “The CAM expenditures were dwarfed by the high cost of conventional care.”

On pg 401 (end of the first paragraph) they state “insurance coverage of licensed CAM providers does not lead to runaway utilization.”. They were surprised. They stated (end of 401) “We did not expect to find that CAM care would account for such a small proportion of insurance expenditures”….and on the beginning of 402…”Payers have resisted covering CAM providers in part because of a fear that coverage would result in large, steadily increasing, and unpredictable expenditures for CAM services, not unlike the history of prescription drug coverage. Our study performed 6 years after the mandated inclusion of CAM benefits in Washington State suggests that this is not going to be the case.”

Also recognize that the WA law mandates new services…basically enforces coverage for all licensed providers, any service that they are licensed to provide. It does not limit—as S. 39 does—coverage to “routine covered services.” So S. 39 represents a tiny fraction of a tiny fraction of what this study looks at.

Lorilee Schoenbeck ND, VANP President