Stason William B, Ritter Grant A, Martin Timothy, Prottas Jeffrey, Tompkins Christopher, Shepard Donald S
Schneider Institutes for Health Policy, The Heller School, MS 035, Brandeis University, Waltham, Massachusetts, United States of America.
PLoS One. 2016 Feb 29;11(2):e0147959. doi: 10.1371/journal.pone.0147959. eCollection 2016.
Moderately convincing evidence supports the benefits of chiropractic manipulations for low back pain. Its effectiveness in other applications is less well documented, and its cost-effectiveness is not known. These questions led the Centers for Medicaid and Medicare Services (CMS) to conduct a two-year demonstration of expanded Medicare coverage for chiropractic services in the treatment of beneficiaries with neuromusculoskeletal (NMS) conditions affecting the back, limbs, neck, or head.
The demonstration was conducted in 2005-2007 in selected counties of Illinois, Iowa, and Virginia and the entire states of Maine and New Mexico. Medicare claims were compiled for the preceding year and two demonstration years for the demonstration areas and matched comparison areas. The impact of the demonstration was analyzed through multivariate regression analysis with a difference-in-difference framework.
Expanded coverage increased Medicare expenditures by $50 million or 28.5% in users of chiropractic services and by $114 million or 10.4% in all patients treated for NMS conditions in demonstration areas during the two-year period. Results varied widely among demonstration areas ranging from increased costs per user of $485 in Northern Illinois and Chicago counties to decreases in costs per user of $59 in New Mexico and $178 in Scott County, Iowa.
The demonstration did not assess possible decreases in costs to other insurers, out-of-pocket payments by patients, the need for and costs of pain medications, or longer term clinical benefits such as avoidance of orthopedic surgical procedures beyond the two-year period of the demonstration. It is possible that other payers or beneficiaries saved money during the demonstration while costs to Medicare were increased.
有适度的确凿证据支持脊椎按摩疗法对腰痛的益处。其在其他应用中的有效性记录较少，且其成本效益尚不清楚。这些问题促使医疗保险和医疗补助服务中心（CMS）进行了一项为期两年的示范项目，扩大医疗保险对脊椎按摩服务的覆盖范围，用于治疗患有影响背部、四肢、颈部或头部的神经肌肉骨骼（NMS）疾病的受益人。
该示范项目于2005 - 2007年在伊利诺伊州、爱荷华州和弗吉尼亚州的选定县以及缅因州和新墨西哥州全州进行。收集了示范地区和匹配对照地区前一年及两个示范年的医疗保险理赔数据。通过采用差异中的差异框架的多元回归分析来分析该示范项目的影响。
在两年期间，扩大覆盖范围使示范地区脊椎按摩服务使用者的医疗保险支出增加了5000万美元，即28.5%，使所有接受NMS疾病治疗的患者的医疗保险支出增加了1.14亿美元，即10.4%。各示范地区的结果差异很大，从伊利诺伊州北部和芝加哥县每位使用者成本增加485美元到新墨西哥州每位使用者成本降低59美元以及爱荷华州斯科特县每位使用者成本降低178美元不等。
该示范项目未评估对其他保险公司成本可能的降低、患者自付费用、止痛药的需求和成本，或超过示范项目两年期的长期临床益处，如避免骨科手术。在示范期间，其他付款人或受益人有可能节省了资金，而医疗保险的成本却增加了。
