01.22.2016
Acupuncture, chiropractic, and massage use climbed despite no insurance coverage

by Sarah Wickline Wallan
Staff Writer, MedPage Today

Lack of insurance hasn’t discouraged Americans from availing themselves of chiropractors, acupuncture, and massage therapy, a government study indicated.

According to survey results, between 30% to 40% of adults in the U.S. used one of these complementary approaches, and across the board, all three therapies were utilized by more adults in 2012 than in 2002, according to Richard L. Nahin, PhD, MPH, of the NIH’s National Center for Complementary and Integrative Health in Bethesda, Md., and colleagues.

The survey data also revealed increased use in chiropractic, acupuncture, and massage therapy, despite a lack of increase in insurance coverage for those services. For adults who were covered for these services, partial coverage rates were roughly double the rates of complete coverage for acupuncture and chiropractic, unlike the near-even split for massage therapy, they wrote in an NCHS Data Brief.

The researchers focused on the three most commonly licensed practitioner-based complementary health approaches: acupuncture, chiropractic, and massage therapy. The data was compiled from National Health Interview Surveys (NHIS) that were conducted in the U.S. from 2002 to 2012.

Chiropractic care was utilized the most with 7.5% of adults reporting visits in 2002 and 8.3% reporting visits in 2012. The second highest was massage therapy, which 5.0% of adults in 2002 and 6.9% of adults in 2012 saying they had massages.

Acupuncture was only used by 1.1% of adults in 2002 and 1.5% of adults in 2012.

The greatest gains in use across the decade from were seen among users of massage therapy with a 1.6% absolute increase.

Most of the people who visited a chiropractor said their insurance covered the service (P<0.05). However, most people who went to an acupuncturist or a massage therapist did not have insurance that included that service (P<0.05).

Insurance changes did not differ greatly for acupuncture services as 0.3% of those who went in for treatment in 2002 and 0.4% who went in for treatment in 2012 were covered by their plans. The increase in acupuncture visits occurred mostly among individuals who did not have treatment coverage from 0.6% in 2002 to 1.1% in 2012.

A similar trend was seen for chiropractor visits and massage therapy. From 2002 to 2012, adults who went to see a chiropractor, but did not have insurance coverage for that service, increased from 2.2% to 3.3%. But the same increase was not seen among those who had chiropractic coverage (4.8% versus 5.1%).

And for massage therapy, the increase in use went from 3.8% in 2002 to 5.8% in 2012 for individuals who didn’t have the service covered, and only from 0.7% to 1.0% for those who did.

“These data suggest that consumers are increasingly willing to pay out of pocket for the use of acupuncture, chiropractic, and massage,” the authors wrote.

Among those adults who had insurance coverage for complementary approaches, more often than not, they only had partial coverage for the service. For acupuncture, 75% had no coverage, 16.5% had partial, and 8.5% had complete coverage.

Out of those who saw a chiropractor, 39.9% had no coverage, 41.4% had partial coverage, and 18.7% had complete service coverage. And among the adults who went to a massage therapist, 84.7% had no insurance coverage, 8.3% had partial coverage, and 7.0% had complete coverage.

“The amount and type of health insurance coverage for acupuncture, chiropractic, and massage therapy may change as state laws on coverage for these complementary health approaches continue to develop,” the authors noted.