Expenditures for treatment of back and neck problems have nearly doubled since the late 1990s—mainly from increased spending for care provided by medical specialists, according to a report in the September 1 issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
At the same time, spending on primary care, chiropractic care, and physical therapy for spinal problems has held steady or decreased, reports the study by Matthew A. Davis, DC, MPH, and colleagues of The Dartmouth Institute, Lebanon, N.H. The researchers write, "Recent increasing costs associated with providing medical care for back and neck conditions (particularly subspecialty care) are contributing to the growing economic burden of managing these conditions."
Where Does the U.S. Spend its 'Spine Dollars'?
Using a healthcare expenditures database, Dr Davis and colleagues analyzed trends in spending for ambulatory care (that is, in non-hospitalized patients) for back and neck problems from 1999 to 2008. Their goal was to evaluate overall trends in spending for spinal care in United States, as well as in patterns of spending for different types of health care providers.
In 2008, approximately six percent of U.S. adults made an ambulatory care visit for diagnosis of a back or neck condition—a total of 13.6 million visits. The percentage of patients making spinal care visits remained "remarkably stable" throughout the decade.
Adjusted for inflation, annual medical spending for spinal care per patient increased by 95 percent: from $487 to $950 (in 2008 dollars). Most of the increase in spending was for care provided by medical specialists. In contrast, there was little or no change in spending for spinal care provided by primary care doctors: family physicians, internists, or general practitioners.
Spending for spinal care provided by chiropractors also remained stable. Care provided by physical therapists was the most costly service throughout the study decade, but spending for physical therapy appeared to decrease over time