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Delisting Chiropractic Doesn’t Make Business Sense

By: Dr. Eleanor White

The Ontario government may be guilty of the practice of being pennywise and pound-foolish. Its decision to delist chiropractic care from provincial healthcare plans may just drive more people to their family doctors and hospitals, says Dr. Eleanor White, of the Ontario Chiropractic Association.

Chiropractic care in Ontario has become the latest in an ever-expanding list of services to be delisted from provincial healthcare plans. Since chiropractic patients and extended health plans will bear the brunt of this cost shifting, employers, workers, insurers, and other EHC plan stakeholders may want to look at available data to see how the provision of access to chiropractic care stands to affect public and private health care.

In May 2004, the Ontario government announced the introduction of the Ontario Health Premium (tax) along with delisting of optometry, physiotherapy, and chiropractic services – without prior warning or consultation. “This change has been challenging for employers, especially those with national workforces. Not only do some of them need to consider the implication of collective agreements, and how they are interpreted, but many other factors come into play such as consistent treatment across provinces and possible changes to employee cost-sharing,” says Joy Sloane, a partner in the benefits consulting practice at Morneau Sobeco.

Better Access
Ostensibly, Ontario made these changes in order to finance better access to care. However, a closer evaluation suggests health costs will increase and access to care will suffer. A report issued by Deloitte Consulting concluded that many patients will now seek fully subsidized care from already overloaded family practitioners and hospital emergency rooms for back pain and other neuromusculoskeletal disorders treated routinely by chiropractors. “Not only will this result in millions of additional doctor and hospital visits,” says Hy Eliasoph, director of the national health services consulting group at Deloitte Consulting in Toronto, “but rather than saving $100 million, it could cost the healthcare system as much as $125 million more.”

Of course, that figure doesn’t factor in the additional cost to individual patients, or to extended health plans. “Long term, every time you turn around, governments are downloading,” says Ken Stewart, manager of pension and benefits at NCR Canada. Chris Schenk, research director at the Ontario Federation of Labour, adds that such decisions are “inequitable and shortsighted… they ignore the health of workers.”

Crucial Role
Plan sponsors contemplating the role chiropractic care can play in the workplace should consider the crucial role played by chiropractors in the treatment of low back pain, a condition that affects 85 per cent of the working population at some point in their life and accounts for one-third of lost time claims. Data recently released by the Ontario Workers’ Safety and Insurance Board demonstrates that workers with acute lower back injuries who received chiropractic care recovered more quickly, completed treatment sooner and, most important of all, returned to work in less than half the time.

Given that back pain afflicts more working Canadians than any other medical condition and is the second leading cause of hospitalizations, restricted activity, and use of nonprescription and prescription drugs, managing this condition cost-effectively makes good business sense. Afour-year retrospective study of 1.7 million members of a managed care network released in October 2004 in the American Medical Association journal Archives of Internal Medicine found that overall healthcare costs were reduced by almost two per cent, with savings attributed to lower patient fees, substitution effects such as reduction in drug costs, and use of less invasive treatments by chiropractors.

Deloitte’s Eliasoph says while private health plan sponsors are rightfully concerned about sustainability issues amid ongoing government rollbacks, in the case of chiropractic care they should consider the cost and impact on productivity.

Those Canadians who have joined the growing numbers who utilize chiropractic care as an effective healthcare option are frustrated about barriers to access because they know that chiropractic works. These workers and the majority of extended health plan sponsors know something that public policy planners don’t – chiropractic coverage equals lower costs and a healthier, more present, and more productive work force.

Dr. Eleanor White is a practicing chiropractor and chair of the Ontario Chiropractic Association’s extended health insurance and labour committee.

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