Expenditures for treatment of back and neck problems have nearly doubled since late 1990s

Expenditures for treatment of back and neck problems have nearly doubled since the late 1990s—mainly from increased spending for care provided by medical specialists, according to a report in the September 1 issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

At the same time, spending on primary care, chiropractic care, and physical therapy for spinal problems has held steady or decreased, reports the study by Matthew A. Davis, DC, MPH, and colleagues of The Dartmouth Institute, Lebanon, N.H. The researchers write, "Recent increasing costs associated with providing medical care for back and neck conditions (particularly subspecialty care) are contributing to the growing economic burden of managing these conditions."

Where Does the U.S. Spend its 'Spine Dollars'?
Using a healthcare expenditures database, Dr Davis and colleagues analyzed trends in spending for ambulatory care (that is, in non-hospitalized patients) for back and neck problems from 1999 to 2008. Their goal was to evaluate overall trends in spending for spinal care in United States, as well as in patterns of spending for different types of health care providers.

In 2008, approximately six percent of U.S. adults made an ambulatory care visit for diagnosis of a back or neck condition—a total of 13.6 million visits. The percentage of patients making spinal care visits remained "remarkably stable" throughout the decade.

Adjusted for inflation, annual medical spending for spinal care per patient increased by 95 percent: from $487 to $950 (in 2008 dollars). Most of the increase in spending was for care provided by medical specialists. In contrast, there was little or no change in spending for spinal care provided by primary care doctors: family physicians, internists, or general practitioners.

Spending for spinal care provided by chiropractors also remained stable. Care provided by physical therapists was the most costly service throughout the study decade, but spending for physical therapy appeared to decrease over time

Back pain is the second most common reason for medical visits overall, after upper respiratory infections. Dr Davis and coauthors write, "Estimates of the total expenditures on care vary, but the general consensus is that approximately $90 billion is spent on the diagnosis and management of low back pain, and an additional $10 to $20 billion is attributed to economic losses in productivity each year."

The study lends new insights into how the United States spends its "spine dollars." The results show that expenditures for spinal care have nearly doubled over the past decade, and that most of the increase is for care provided by medical specialists—who may rely more heavily on "reimbursable advanced technologies," such as high-tech imaging studies. In contrast, Dr Davis and coauthors write, "Non-technologically based ambulatory health services…such as chiropractic care and physical therapy have not experienced the same increases in expenditures per user."

The researchers acknowledge some limitations of their study—especially the fact that it doesn't evaluate the effectiveness of different types of care for spinal problems. It's particularly important to find out whether the rising costs of specialist care are justified by improvement in patient outcomes. Dr Davis and colleagues conclude, "Future health policy decisions must be informed by the relative cost-effectiveness of ambulatory health services that manage the spine condition population."