Use of Complementary and Alternative Medicine Providers Declines



SEATTLE – After years of growth, the demand for complementary and alternative medicine seems to have leveled off.

Between 2002 and 2008, the total number of ambulatory visits to complementary and alternative medicine (CAM) providers in the United States, including acupuncturists, homeopathists, and chiropractors, decreased 4% from 126 million to 121 million, according to a Medical Expenditure Panel Survey analysis by the Center for Health Policy Research at Dartmouth Medical School, Hanover, N.H.

"This is the first nationally representative study to suggest CAM provider services may be reaching maturity in the U.S.," the researchers concluded at the annual research meeting of AcademyHealth.

"Everyone made big assumptions that CAM is increasing, but it doesn’t seem to be increasing. It appears to be pretty flat, whether you look at per-user or total number of visits or expenditures for illness management," said Dr. Matthew Davis, a chiropractor at the medical school.

The majority of CAM visits are for chiropractic care, but visits to chiropractors have fallen from about 110 million in 2005 to just under 100 million in 2008.

When asked what could be behind the results, Dr. Davis noted that CAM’s popularity historically runs in cycles. Also, he noted that overall spending on elective health care has been down during the recession.

Even so, a significant amount of money is still spent on CAM services, and it’s increased from about $8 billion in 2002 to $8.6 billion in 2008, even as overall visits have declined. Chiropractic care accounts for most of the increase, while spending on acupuncture, massage therapy, and other modalities has remained largely stable, according to the study.

Study Shows Distinct Focus of CAM Spending

In a second study, Dr. Davis and his colleagues found that spending on CAM is concentrated in a minority of users, with about 25% accounting for 72% of spending. The results are based on an analysis of the 2007 National Health Interview Survey, which included questions about 18 kinds of CAM.

That’s similar to traditional medicine, but in traditional medicine, it’s a minority of older, sicker individuals who account for a majority of spending. In contrast, it seems the worried-well account for much of the spending on CAM.

After adjusting for age, sex, education, marital status, and race, the investigators found that self-reported health status was not associated with CAM spending among the almost 3,000 people surveyed. "Heavier spenders" – those who spent $520-$10,000 in 2007 – "aren’t any sicker than light spenders," those who spent less than $87. "We found very little if any relationship between the two," said Dr. Davis. About 11% in both the heavy and light spending groups reported fair to poor health.

Heavy users tend to be a little older and are more likely to be female. These people have an interest in staying well and spend money on health services. "Also, [CAM spending] probably has to do with empowerment. We live in a culture where people like to take care of their own health, and I think CAM offers that to some people," Dr. Davis said.

The Dartmouth researchers estimated that in 2007 the top 10% of users, accounting for almost half of expenditures that year, spent a mean of $2,392.

Among other findings for 2007: $165 million was spent on homeopathy, $271 million on naturopathy, $103 million on traditional healers, $19 million on ayurveda, $567 million on herbals and other nonvitamin supplements, $32 million on chelation, and $74 million on hypnosis.

Overall, CAM accounts for less than 1% of total health care spending in the U.S., and, unlike traditional medicine, largely "remains a cottage industry," Dr. Davis said.

Dr. Davis reported no relevant disclosures. The studies were funded by the National Center for Complementary and Alternative Medicine.

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