Complement Ther Med. 2017 (Jun); 32: 116–128 ~ FULL TEXT
Department of Economics,
University of Waterloo,
200 University Avenue West,
Waterloo, ON N2L 3G1, Canada
Health related absenteeism costs an estimated $153 billion annually in the United States (Witters and Agrawal, 2011).1 Chronic conditions (major contributors to absenteeism) are often successfully managed by Complementary and Alternative Medicine (CAM). As CAM becomes an increasingly visible component of healthcare, firms may wish to consider whether CAM therapies can help reduce illness-related absenteeism. This paper aims to extend the literature on healthcare utilization and absenteeism by exploring whether CAM treatment is associated with fewer workdays missed due to illness.
METHODS: Using the 2007 National Health Interview Survey (NHIS) and propensity score matching (PSM), this study estimates the relationship between visits to CAM practitioners, health, and illness-related absenteeism.
RESULTS: In a sample of 8820 workers, the average annual number of workdays lost due to illness is 3.69. Visiting an acupuncturist correlates with lower absenteeism among men (1.182 fewer workdays missed, p<0.05), whereas visiting a naturopathic doctor correlates with 2.359 and 2.521 fewer workdays missed for women and men, respectively (both p<0.001). Active mind-body practices, massage, chiropractic and acupuncture treatments are all significantly associated with improved health.
CONCLUSIONS: Estimates suggest that some CAM modalities correlate with lower absenteeism, and many correlate with improved health. Two limitations of this study are worth noting. First, a small proportion of the sample uses CAM, limiting the generalizability of results. Second, if health conscious individuals are more likely to use CAM, then health attitudes may be contributing to lower absenteeism among the treated. Further research is needed to identify a causal relationship between CAM treatment, health, and absenteeism.
KEYWORDS: Complementary and alternative medicine; Health; Illness-related absenteeism
From the FULL TEXT Article:
With the high costs of illness-related absenteeism, employersand policy makers are interested in treatments and interventionsthat might reduce sick days and improve worker health. Majorcontributors to absenteeism, chronic conditions, are shown to beeffectively treated (or managed) by Complimentary and Alterna-tive Medicine (CAM).2–7A growing body of literature exploresthe relationship between CAM and absenteeism. Such researchis increasingly important as the healthcare industry continues toshift toward preventive care. Insurance coverage of CAM, whichhas already risen in the previous decade, may rise further because the Affordable Care Act (2010) prohibits insurers from discriminat-ing against any licensed or certified health service provider.
Therefore, it is important to determine whether CAM can be effective in improving worker health and reducing absenteeism.
This study expands the literature by exploring the relationshipbetween CAM treatment and absenteeism using nationally repre-sentative survey data. Specifically, this study investigates whetherworkers that visit a CAM practitioner exhibit improved health ormiss fewer workdays due to illness. Five different CAM practices areconsidered: active mind-body (e.g. yoga, meditation), naturopathy,massage therapy, chiropractic and acupuncture. Results indicatethat visiting an acupuncturist is associated with lower absenteeismfor men, whereas visiting a naturopathic doctor correlates withfewer illness-related absences for both sexes. Active mind-bodytechniques, massage, chiropractic and acupuncture treatments areall significantly associated with improved health.
Health related absenteeism costs an estimated $153 billion annually in the United States.  As such, understanding what factors contribute to absenteeism is a concern for employers and policy makers alike. One major contributor to absenteeism is chronic conditions. Lower back pain, diabetes, arthritis, allergies, asthma, menstrual pain, migraines, cancer, obesity, and several mental conditions (e.g. bipolar disorder, anxiety, depression) correlate with greater absenteeism and absenteeism costs. [1, 11-22] For example,the odds ratio on absenteeism is two times higher for those with a recent depressive episode,  and migraine victims lose an estimated 4–5 workdays annually.  Moreover, chronic conditions comprise the largest share of healthcare spending: 75% of spending is devoted to chronic conditions, adding about $3,600 per person per year to employer healthcare costs. 
Interestingly, many of the chronic conditions associated with absenteeism are conditions for which Complementary and Alternative Medicine (CAM) is found to be effective. Research suggests that several types of CAM may be effective in preventive care, treating non-acute illness, and managing a variety of chronic conditions. [2-7] As an example, massage therapy may relieve back pain. [4, 6] Acupuncture can relieve pain and improve functionality for those suffering from headaches, lower back pain, menstrual pain and osteoarthritis of the knee, and is also associated with reduced nausea for postoperative cancer patients. [3, 5, 6, 24, 25] Mind-body techniques and some herbal products may be effective in lowering glucose levels, cholesterol, and body weight, and improving physical and psychologicalwellbeing. 
A growing body of literature explores the relationship between absenteeism and use of alternative, as well as mainstream, medical treatments. [22, 26-31] For example, a recent longitudinal analysis finds that CAM treatments are effective in reducing long-term absenteeism for individuals with several neurotic conditions.  Another U.S. based study reports that unlimited acupuncture, when introduced for a trial period, resulted in lower pain and zero absenteeism over the trial period.  Controlling for self-selection, spa visits reduced absenteeism and lowered rates of hospitalization in a German study.  Timing of treatment may matter as well. A recent Dutch study reports that visiting a physical therapist, general practitioner or specialist, can shorten the duration of an absence if the visit occurs eight weeks into the leave, rather than at the start of the leave, for individuals with non-specific musculoskeletal issues.  Treatments may be funded out-of-pocket, but may also be covered by employers who wish to benefit from more productive workers.
Kaiser Permanente, one of the largest managed care organizations in the U.S., suggests that investing in preventive care and employee wellness programs has reduced absenteeism, increased productivity, and provided substantial cost savings.  This statement is supported by several recent papers, which find that employee assistance plans, occupational health, wellness programs and other workplace interventions may improve health and work outcomes. [23, 32-40] Employee assistance programs can identify health concerns and increase use of other healthcare resources, particularly for alcohol, drug and mental health concerns.  One U.S.study estimates an average loss of 2.6 workdays (per worker) if employee assistance program services are not provided.  Results from another workplace study suggest that intervention, in the form of an online mindfulness program, can reduce stress and increase work engagement. 
This paper extends the topic of healthcare and absenteeism by exploring the relationship between use of CAM, worker health, and illness-related absenteeism. Using propensity score matching and nationally representative survey data, this study estimates treatment effects for five separate CAM practices: active mind-body, naturopathy, massage therapy, chiropractic andacupuncture.
As Complementary and Alternative Medicine (CAM) becomes an increasingly visible component of healthcare, firms may consider whether CAM therapies improve health and reduce absenteeism among workers. This study reports a range of estimates on the relationship between CAM and illness-related absenteeism. Results suggest that visiting an acupuncturist is associated with lower absenteeism among men, whereas naturopathic treatment correlates with fewer absences for both sexes. Active mind-bodypractices, massage, chiropractic and acupuncture treatments are all significantly associated with improved health.
Empirical results from this study should be interpreted with suitable caution. First, estimates may identify correlation rather than causation if there are unobserved factors that drive selection into treatment as well as health. For example, use of CAM is associated with eating more vegetables and less dairy fat (but more fastfood), and more regular exercise. Indeed, some research suggeststhat firms may offer coverage of CAM treatments in order to attract lower risk clients who take care of themselves. [8, 72] At the same time,CAM patients frequently exhibit chronic and more severe forms of disease. 
Second, only a small fraction of the sample visits naturopaths and acupuncturists. Therefore, even with sample-weighted specifications, these results may not be generalizable to the entire population. However, the consistently negative correlation between naturopathy and illness related absence suggests that naturopathic therapies may reduce illness, or may attract healthy workers. Future research, with larger subsamples and more detailed information on timing of treatment, could lend support to the results found in this study. As well, information onexogenous changes to insurance coverage (e.g. with proprietary firm-insurance level data) could help identify causality by servingas instruments for treatment.