The mission of Alberta’s Expert Advisory Panel is to ensure that the province’s publicly funded health services remain comprehensive, sustainable, and good value. The panel’s most important considerations are effectiveness and cost-effectiveness. The chiropractic section of its first progress report (shown below) expressed concern about rising costs and recommended that chiropractic services be limited to treatment for pain related the muscles and joints of the spine and pelvis.
Chiropractic services are not covered under the Canada Health Act. Currently, the Alberta Health Care Insurance Plan provides coverage for chiropractic services up to a maximum of $200 per person per year. 418,000 clients were served in 2000-01 and close to three million services were provided. 85% of the clients are 19 years of age and older. Since 1997, chiropractic services have grown by 5.7% per year. In 2000-01, the Alberta Health Care Insurance Plan paid $36.5 million for chiropractic services. Chiropractors are allowed to charge patients a co-payment over and above the rate paid by the Alberta Health Care Insurance Plan.
Research Group Findings
Chiropractic services do not fail the technical screen.
Chiropractic services may not pass the social and economic screen.
Chiropractic services may not pass the fiscal screen.
Assessment by the Expert Advisory Panel
The Panel reviewed the findings of the Research Group and, based on the evidence available and the burden of proof for currently funded services, concluded that chiropractic services did not fail the first screen. In terms of the second screen, opinion was divided and the majority of Panel members did not support continued public funding for all chiropractic services.
The Panel was concerned primarily with continuing access to treatment for back pain. Both chiropractic services and physical therapy can be used to treat back pain. Research reviewed by the Research Group indicates that there is no evidence to suggest that one type of treatment is preferable than the other. Both can be effective for specific individuals and under certain conditions. Consequently, the Panel’s view is that funding for chiropractic treatments and physical therapy treatments for back pain should be handled in a consistent way. If public funding is not provided for either chiropractic care or community physical therapy, there would be a significant gap in access to treatment for back pain. The Panel therefore concluded that continued public funding was important to ensure access to treatment in the community.
The Panel also considered whether or not public funding for the treatment of back pain (provided by either chiropractors or physical therapists) should be restricted to adults only. Because 85% of the clients are 18 years of age and older, limiting the services to adults would ensure that funding is targeted to those who use the services the most. However, there are cases where adolescents, in particular, may have back pain as a result of sports injuries, falls, or other causes. Therefore, an argument was made that they should have access to publicly funded treatment for back pain on the same conditions as adults. On the other hand, back pain is not common in young children and can be a result of serious medical conditions. Chiropractors who see children with health-related back pain would typically refer them to physicians. While there is no evidence to suggest that the treatment of back pain in young children by either chiropractors or physical therapists is unsafe, an argument was made that, because of the potentially serious health conditions involved, public funding should not be provided for treatment of back pain in children by either chiropractors or physiotherapists. Children could continue to access these services, but no public funding would be available.
Public funding for chiropractic services should be limited to treatment for pain related to the muscles and joints of the spine and pelvis.
A co-payment should be allowed and an annual cap should be set on the funding to be provided per person per year. A single, annual shared cap should apply to both chiropractic and community physical therapy treatments for pain related to the muscles and joints of the spine and pelvis.
Funding should not be continued for chiropractic services provided outside the province or outside Canada.
The Panel supports public funding for these treatments for adults but was unable to reach a consensus on whether or not public funding should be provided for treatment of back pain in children by either chiropractors or physiotherapists.
Advice to Minister
This page was posted on June 16, 2008.