BACKGROUND: About 34% of visits to chiropractors are made by patients who are members of a managed care organization. But there has been little scientific research to gauge the effects of managed care membership on chiropractic expenditures. The Medical Expenditure Panel Survey (MEPS) is a survey that is representative of the U.S. population. The 1996 MEPS panel reports on 4,070 visits made to chiropractors in that year. We report on the findings of a multivariate analysis of predictors of out-of-pocket (OOP) payments for chiropractic visits.
METHODOLOGY: After eliminating univariate and multivariate outlier observations and variables with multicollinearity effects, we identified 14 first-order variables. These 14 variables and their second-order effects were entered into a forward stepwise model. Using Mallow's Cp and other regression diagnostics, a regression model with 108 parameters was created.
FINDINGS: Managed care patients paid $7.84 more for out-of-pocket expenses per visit than patients in traditional insurance arrangements. The adjusted R-squared for the model was .53. Almost half of that finding—.25—was accounted for by the interaction of managed care status with other predictor variables.
RECOMMENDATIONS: The RAND Health Insurance Experiment found that chiropractic services are highly price-sensitive. The public, the chiropractic profession, and policy-makers need to be educated about the effects of increased insurance co-payments on chiropractic utilization.
Learning Objectives: 1. Describe the utility of MEPS for chiropractic health services research. 2. Explain the first- and second-order effects of managed care on out-of-pocket payments. 3. Highlight the likely effects of increased OOP payments on chiropractic utilization.
Keywords: Chiropractic, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None