Geographical variation in the rates of use of chiropractic manipulation treatment in Northern New England

In recent years, some states have established all-payer claims databases (APCDs) to collect health care claims data from all insurers across an entire state. These databases provide a rich source of data for analyzing utilization, cost, and quality of health care and for evaluating the effectiveness of delivery system reforms to reduce cost and improve quality. Using APCDs for residents of northern New England (Maine, New Hampshire, Vermont), the variation in rates of chiropractic and osteopathic manipulation use for the commercially insured population were evaluated. Among 67 geographical areas, the rate of manipulation varied nine-fold in northern New England. Variation chiropractic care rates will be discussed in relationship to other indicators: back surgery rates and episode of care analysis of cost for treatment of low back conditions using APCD data. The findings have implications for promotion of health and patterns of treatment of care in these community areas.