Medical Costs For Back And Neck Problems
Are Rising, But Health Outcomes Are Not Improving
The amount of money people spend to treat their back and neck problems has
increased substantially in the last decade. Despite this, their health
status does not seem to be comparably improving, according to a study in
the February 13 issue of JAMA.
In clinical practice, back and neck problems are some of the most commonly
experienced symptoms. In 2002, a survey of adults in the United states
showed 26 percent reporting lower back pain and 14 percent reporting neck
pain in the three months previous, according to the background information
in the article. Imaging and therapy rates for back and neck/spine problems
have increased considerably in the last decade, but it is not clear how
this has affected expenditures or health outcomes for patients with these
problems.
In this article, Brook I. Martin, M.P.H., of the University of Washington,
Seattle, and colleagues conducted a study to analyze just this. They used
data from the nationally representative Medical Expenditure Panel Survey (MEPS)
from 1997-2005. Of the total of 23,045 U.S. Adults over the age of 17 who
responded in 1997, 3,139 reported spine problems. In 2005, of total 22,258
respondents, 3,187 reported spine problems.
Those with spine problems had higher expenditures than those without,
according to the researchers. After adjusting for age, sex, and inflation,
the average expenditure of a patients with spine problems in 1997 was
$4,695, in contrast with $2,731 for those without. In 2005, the average
for those with spine problems was $6,096, while those without spent an
average of just $3,516. From 1997 to 2005, this shows an estimated 65
percent inflation-adjusted increase in total expenditure of adults with
spine problems. This is a more rapid increase than overall health
expenditures.
Many of the differences observed in these inflation-adjusted expenditures
between those with and without spine problems in 2005 could be attributed
to outpatients services (36%) and inpatients services (28 percent.) To a
lesser extent, prescription medications (23 percent), emergency department
visits (3 percent) and home health, dental, and other expenses (10
percent) accounted for the discrepancy.
Physical functioning limitations reported by persons with back or neck
problems increased from an estimated 20.7 percent to 24.7 percent from
1997 to 2005. Accordingly, self-reported measures of mental health,
physical functioning, limitations at work or in school, and limitations in
social settings among adults with spine problems were worsened from 1997
to 2005.
The authors conclude that spine problems are a significant contribution to
medical costs without direct improvements in the health outcomes.
"These data suggest that spine problems are expensive, due both to
large numbers of affected persons and to high costs per person. We did not
observe improvements in health outcomes commensurate with the increasing
costs over time. Spine problems may offer opportunities to reduce
expenditures without associated worsening of clinical outcomes."
Expenditures and Health Status Among Adults With Back and Neck Problems
Brook I. Martin, Richard A. Deyo, MD, MPH, Sohail K. Mirza, Judith A.
Turner, Bryan A. Comstock, William Hollingworth, Sean D. Sullivan
JAMA, February 13, 2008-Vol 299, No. 6
http://jama.ama-assn.org
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