Economic Case for the Integration of Chiropractic Services
into the Health Care System

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org

FROM:   J Manipulative Physiol Ther 2000 (Feb);   23 (2):   118–122

Pran Manga, PhD

Director, Masters Program in Health Administration, University of Ottawa, Ottawa, Ontario, Canada

For much of its history, chiropractic care has been both an alternative therapeutic paradigm and separate from or marginal to the mainstream health care system. Over the past decade, the situation has changed somewhat in that chiropractic care is gradually being integrated within a variety of health care delivery organizations. According to Triano et al,1 by the application of evidence-based health care and good business, there is a surge in cooperation and integration among chiropractors, allopathic physicians, allied health care providers, ancillary therapists, and respective support staff. There is, however, no quantification of the level of integration. Integration may also be more true of the United States than elsewhere. The overall position of chiropractic care as alternative and separate still predominates. This situation does not serve the interests of the chiropractic profession nor the public well. There is a persuasive economic case for a radical shift in the role of chiropractic care to one that may succinctly be described as alternative and mainstream. The chiropractic profession must preserve its identity and its unique therapeutic paradigm and continue to be seen as an alternative to other health care professions, especially medical doctors. However, it should also become mainstream and thus widely available and accessible to the public by being integrated into the wide variety of health care delivery organizations that collectively constitute the health care system.

There are considerable and persuasive economic and related arguments for this integration. Fundamentally, the integration of chiropractic care into the health care system is the solution to a set of 3 interrelated problems: (1) very high direct health care costs and indirect costs for the treatment of neuromusculoskeletal (NMS) conditions and injuries, (2) inadequate and inequitable access to effective and safe services offered by chiropractors, and (3) poor or worrisome health outcomes of medically managed NMS diseases, illnesses, or injuries. The desired integration can lead to improved health outcomes, significantly reduce health care costs, and improve accessibility to needed health services on the part of several socioeconomic groups who, under the current public and private insurance coverage guidelines, do not have adequate access to care.

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