CWCI Study Examines Chiropractic Utilization and Costs in Calif WC

March 26, 2003

The California Workers’ Compensation Institute (CWCI) has issued new research showing the combined effect of an increase in the number of chiropractors treating fewer injured workers with higher levels of chiropractic services per claim has been to drive up both the average cost and the overall cost of chiropractic care in California workers’ compensation.

California’s workers’ compensation insurer payments to chiropractors climbed from $77 million in 1996 to $195 million in 2001 (a 153 percent increase over six years) pushing chiropractors’ share of the workers’ comp medical dollar from 11.4 percent to 17 percent, as they surpassed clinics, orthopedists, and physical therapists to become the number one classified medical specialty group rendering treatment to California’s injured workers.

Notably, the study found that chiropractic costs more than doubled, even though both the number of work injuries in the state and the proportion of workers’ comp claims involving chiropractic care declined. Reviewing data from more than 130,000 1993-2000 work injury claims involving chiropractic care, the Institute found that increased utilization of services was the key cost driver. For example, the average number of chiropractic visits per claim increased by almost 50 percent from 20.2 to 29.9 visits in six years, the average number of procedures per claim doubled from less than 59 to more than 120, and the array of different procedures used per claim increased from 6.3 to 8.0.

The study also noted that most of the increases in utilization occurred within the first year of injury, suggesting that chiropractors were rendering more aggressive treatment in the early stages of a claim. Furthermore, the report notes that the number of work injury claims was declining as the number of chiropractors was climbing, so the ratio of chiropractors to injured workers increased by one-third between 1995 and 2000. The association between an increasing ratio of providers to injured workers and rising costs and utilization is known as physician-induced demand.

CWCI has published the study in a report, “Changes in Utilization of Chiropractic Care in California Workers’ Compensation, 1993-2000.” Contact the CWCI at 510-663-1063 or visit for information on how to obtain the report.

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