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State Health Notes
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September 25, 2000
Volume 21, Number 333
National Conference of State Legislatures
Alternative Medicine: Working its Way into the U.S. Health System Mainstream
The gains may be measured by baby steps, but alternative medicine is slowly being
integrated into America’s health care system. For while many in mainstream medicine
may still view alternative, or complementary, practitioners—chiropractors,
acupuncturists, massage therapists, naturopaths, nutritionists and the like—with some
suspicion, patients are increasingly driving demand for their services. Documenting
the trend between 1990 and 1997, a Nov. 11, 1998 Journal of the American Medical
Association article reported a 47.3 percent jump in the number of visits to alternative
medicine practitioners, from 427 million to 629 million, “exceeding total visits to
all primary care physicians.” Over the same period, it said, expenditures on alternative
medicine services rose by 45.2 percent and were “conservatively estimated” at $21.2
billion in 1997.
Acknowledging the interest, President Clinton in March named a White House Commission
on Complementary and Alternative Medicine (CAM) Policy, asking for recommendations on
ways to assure that public policy “maximizes the benefits” of the increasingly popular
field. The move follows the 1998 creation of a National Center for Complementary and
Alternative Medicine at the National Institutes of Health to conduct research into
various therapies and healing philosophies and disseminate the information to
practitioners and the public.
On Sept. 6, the Journal highlighted yet another milestone: for the academic year
1999-2000, two of three U.S. medical schools included CAM-related content as part of a
required course, and one of two offered an elective course. Along with consumer
demand, the “tremendous interest on the part of medical students” will help to foster
greater integration of CAM services with conventional medicine, said Candace Campbell,
executive director of the American Preventive Medicine Association, which describes
itself as “the political voice” for alternative practitioners. And while many
courses—biofeedback, nutrition and stress reduction, for instance—are perhaps perceived
by physicians as “non-threatening,” their inclusion “is a good start,” she said,
giving medical students a basic understanding of how the therapies might help their
own patients later down the line.
INROADS; LICENSURE AND REIMBURSEMENT
One paramount goal of the integrated medicine movement is to convince insurers to
pay for services rendered. According to the 1998 JAMA piece, patients paid “at
least” $12.2 billion of the $21.2 billion spent on CAM services in 1997 out of
their own pockets, with “no statistically significant” changes in insurance
coverage noted over the eight-year study period. Given the growing demand, however,
there are signs of change. A report released by California-based Landmark
Healthcare Inc., in March 1999, for instance, found that two-thirds of 449 health
plans surveyed offer coverage for at least one form of alternative care. Of the lot,
38 percent cited demand from members and employers as the key factor in their
decisions, while 38 percent named benefit mandates or other legal requirements.
(Based on a 1999 survey by the Blue Cross Blue Shield Association, state mandate
totals for four major CAM categories are: chiropractors, 44; acupuncturists, 7;
naturopaths, 4; and massage therapists, 2.)
But John Weeks, publisher of The Integrator, a newsletter following trends in the
field, said the coverage data are “sort of like Wonder Bread, squishy” because they
don’t reflect the dollar or visit limits most plans impose nor the fact that most
offer only “discounts” for services rather than full coverage. “There has been
growth if you step back ten years,” he said, but because most plans also don’t
contract with CAM networks, patients seeking coverage of treatment for a specific
therapeutic condition by a specific provider aren’t likely to succeed, and if they
can get a referral, “it will be for one or two visits,” not enough to treat most
conditions.
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