Online Program

Comparison of management costs of neck pain according to pattern of care: The North Carolina state health plan for teachers and state employees, 2000-2009

Monday, November 4, 2013 : 2:30 p.m. - 2:40 p.m.

Eric L. Hurwitz, DC, PhD, Department of Public Health Sciences, University of Hawaii at Manoa, Honolulu, HI
Dongmei Li, PhD, Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI
The purpose of this paper is to compare and contrast the management costs of neck pain according to pattern of care. The study includes the claims for 664,000 covered lives in North Carolina from 2000 to 2009. For uncomplicated neck pain (UNP), 2,795,046 claims met the inclusion criteria; for complicated neck pain (CNP), 529,318 claims met the inclusion criteria. Fifteen care patterns involving doctors of chiropractic (DCs), medical doctors (MDs), and physical therapists (PTs) were identified. We computed medical, pharmaceutical, and overall charges according to pattern of care, by patient and claim separately for each year in order to detect trends over time in use and costs. Over the decade, total allowed charges more than doubled for UNP and more than tripled for CNP; average charges increased by 26% for UNP and by 37% for CNP. Mean and median per-patient and per-claim charges associated with both UNP and CNP varied significantly by pattern of care during the 2000-2009 decade. In general, patterns of care involving multiple providers and referrals incurred the largest charges, while patterns of care involving single or non-referral providers incurred the least charges. For both UNP and CNP, MD referrals were much costlier than DC referrals, and MD-PT care with referrals much more expensive than MD-DC care with referrals. For UNP in 2009, care involving MDs was on average $933 (or 47.3%) more expensive than care with DCs. For CNP in 2009, MD care was on average $5298 (or 197%) more expensive than care with DCs.

Learning Areas:

Provision of health care to the public

Learning Objectives:
Compare management costs for uncomplicated and complicated neck pain by patterns of care involving chiropractors, medical doctors, and physical therapists. Identify trends over time (2000-2009) in the management costs of uncomplicated and complicated neck pain for various patterns of care.

Keyword(s): Health Care, Cost Issues

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am Professor and Graduate Chair of Epidemiology and have had several research grants and numerous publications on the epidemiology of neck pain and its associated health care use and costs.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
NCMIC chiropractic Independent Contractor (contracted research and clinical trials)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.