Cooper Richard A, McKee Heather J
Health Policy Institute, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
Milbank Q. 2003;81(1):107-38, table of contents. doi: 10.1111/1468-0009.00040.
Chiropractic is the best established of the alternative health care professions. Although marginalized for much of the 20th century, it has entered the mainstream of health care, gaining both legitimacy and access to third-party payers. However, the profession's efforts to validate the effectiveness of spinal manipulative therapy, its principal modality, have yielded only modest and often contrary results. At the same time, reimbursement is shrinking, the number of practitioners is growing, and competition from other healing professions is increasing. The profession's efforts to establish a role in primary care are meeting resistance, and its attempts to broaden its activities in alternative medicine have inherent limitations. Although patients express a high level of satisfaction with chiropractic treatment and politicians are sympathetic to it, this may not be enough as our nation grapples to define the health care system that it can afford.
整脊疗法是替代医疗保健行业中最成熟的。尽管在20世纪的大部分时间里都处于边缘地位，但它已进入医疗保健主流，获得了合法性并得以接入第三方支付方。然而，该行业为验证其主要治疗方式——脊椎推拿疗法的有效性所做的努力，仅取得了有限且往往相互矛盾的结果。与此同时，报销费用在缩减，从业者数量在增加，来自其他治疗行业的竞争也在加剧。该行业在初级保健领域确立角色的努力面临阻力，其在替代医学领域扩大活动范围的尝试也存在固有局限性。尽管患者对整脊疗法治疗表示高度满意，且政治家也对此表示同情，但在我们国家努力界定其负担得起的医疗保健系统时，这可能还不够。
