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

J Manipulative Physiol Ther. 2016 May;39(4):252-62. doi: 10.1016/j.jmpt.2016.02.006.


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 patterns of care for the treatment of low back pain in North Carolina.

Methods: This was an analysis of low-back-pain-related closed claim data from the North Carolina State Health Plan for Teachers and State Employees from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the North Carolina State Health Plan using International Classification of Diseases, 9th Revision diagnostic codes for uncomplicated low back pain (ULBP) and complicated low back pain (CLBP).

Results: Care patterns with single-provider types and no referrals incurred the least charges on average for both ULBP and CLBP. When care did not include referral providers or services, for ULBP, MD and DC care was on average $465 less than MD and PT care. For CLBP, MD and DC care averaged $965 more than MD and PT care. However, when care involved referral providers or services, MD and DC care was on average $1600 less when compared to MD and PT care for ULBP and $1885 less for CLBP. Risk-adjusted charges (available 2006-2009) for patients in the middle quintile of risk were significantly less for DC care patterns.

Conclusions: Chiropractic care alone or DC with MD care incurred appreciably fewer charges for ULBP than MD care with or without PT care. This finding was reversed for CLBP. Adjusted charges for both ULBP and CLBP patients were significantly lower for DC patients.

Keywords: Chiropractic; Health Services; Healthcare Costs; Low Back Pain; Medical Care; 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*
  • Low Back Pain / economics
  • Low Back Pain / therapy*
  • Manipulation, Chiropractic / economics
  • Manipulation, Chiropractic / statistics & numerical data*
  • Medicine / statistics & numerical data
  • 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