Variations in Patterns of Utilization and Charges for the Care of Neck Pain in North Carolina, 2000 to 2009: A Statewide Claims' Data Analysis

J Manipulative Physiol Ther. 2016 May;39(4):240-51. doi: 10.1016/j.jmpt.2016.02.007.


Objectives: The purpose of the study was to compare utilization and charges generated by medical doctors (MD), doctors of chiropractic (DC) and physical therapists (PT) by provider patterns of care for the treatment of neck pain in North Carolina.

Methods: This was an analysis of neck-pain-related closed claim data from the North Carolina State Health Plan for Teachers and State Employees (NCSHP) from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the NCSHP using ICD-9 diagnostic codes for uncomplicated neck pain (UNP) and complicated neck pain (CNP).

Results: Care patterns with single-provider types and no referrals incurred the least average charges for both UNP and CNP. When care did not include referral providers or services, for either UNP or CNP, MD care with PT was generally less expensive than MD care with DC care. However, when care involved referral providers or services, MD and PT care was on average more expensive than MD and DC care for either UNP or CNP. Risk-adjusted charges for patients in the middle quintile of risk (available 2006-2009) were lower for chiropractic patients with or without medical care or referral care to other providers.

Conclusions: Chiropractic care alone or DC with MD care incurred appreciably fewer charges for UNP or CNP compared to MD care with or without PT care, when care included referral providers or services. This finding was reversed when care did not include referral providers or services. Risk-adjusted charges for UNP and CNP patients were lower for DC care patterns.

Keywords: Chiropractic; Health Services; Healthcare Costs; Medical Care; Neck Pain; Utilization.

MeSH terms

  • Chiropractic / economics
  • Chiropractic / statistics & numerical data
  • Costs and Cost Analysis
  • Fees and Charges / statistics & numerical data*
  • Humans
  • Insurance Claim Review / economics
  • Insurance Claim Review / statistics & numerical data*
  • Manipulation, Chiropractic / economics
  • Manipulation, Chiropractic / statistics & numerical data*
  • Medicine / statistics & numerical data
  • Neck Pain / economics
  • Neck Pain / therapy*
  • North Carolina / epidemiology
  • Osteopathic Medicine / economics
  • Osteopathic Medicine / statistics & numerical data
  • Physical Therapy Modalities / economics
  • Physical Therapy Modalities / statistics & numerical data*
  • Physical Therapy Specialty / economics
  • Physical Therapy Specialty / statistics & numerical data
  • Physicians / economics
  • Physicians / statistics & numerical data
  • Practice Patterns, Physicians' / economics
  • Practice Patterns, Physicians' / statistics & numerical data
  • Retrospective Studies