Insurance coverage and subsequent utilization of complementary and alternative medicine providers

William E. Lafferty, Patrick T. Tyree, Allen S. Bellas, Carolyn A. Watts, Bonnie Lind, Karen J. Sherman, Daniel C. Cherkin, David E. Grembowski

Research output: Contribution to journalArticle

47 Scopus citations

Abstract

Background: Since 1996, Washington State law has required that private health insurance cover licensed complementary and alternative medicine (CAM) providers. Objective: To evaluate how insured people used CAM providers and what role this played in healthcare utilization and expenditures. Study Design: Cross-sectional analysis of insurance enrollees from western Washington in 2002. Methods: Analysis of insurance demographic data, claims files, benefit information, diagnoses, CAM and conventional provider utilization, and healthcare expenditures for 3 large health insurance companies. Results: Among more than 600 000 enrollees, 13.7% made CAM claims. This included 1.3% of enrollees with claims for acupuncture, 1.6% for naturopathy, 2.4% for massage, and 10.9% for chiropractic. Patients enrolled in preferred provider organizations and point-of-service products were notably more likely to use CAM than those with health maintenance organization coverage. The use of CAM was greater among women and among persons 31 to 50 years of age. The use of chiropractic was more frequent in less populous counties. The CAM provider visits usually focused on musculoskeletal complaints except for naturopathic physicians, who treated a broader array of problems. The median per-visit expenditures were $39.00 for CAM care and $74.40 for conventional outpatient care. The total expenditures per enrollee were $2589, of which $75 (2.9%) was spent on CAM. Conclusions: The number of people using CAM insurance benefits was substantial; the effect on insurance expenditures was modest. Because the long-term trajectory of CAM cost under third-party payment is unknown, utilization of these services should be followed.

Original languageEnglish (US)
Pages (from-to)397-404
Number of pages8
JournalAmerican Journal of Managed Care
Volume12
Issue number7
Publication statusPublished - Jul 1 2006
Externally publishedYes

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ASJC Scopus subject areas

  • Health Policy

Cite this

Lafferty, W. E., Tyree, P. T., Bellas, A. S., Watts, C. A., Lind, B., Sherman, K. J., ... Grembowski, D. E. (2006). Insurance coverage and subsequent utilization of complementary and alternative medicine providers. American Journal of Managed Care, 12(7), 397-404.