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Alternative Medicine

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Science & Nature

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The health care industry has a variety of policies and
standards regarding coverages for
modalities. From a sociological standpoint, unconventional,
alternative, or unorthodox therapies refer to medical practices
that are not in conformity with the standards of the medical
community. The New England Journal of Medicine defines
unconventional therapies, 'as medical interventions not taught
widely at U.S. medical schools or generally available at U.S.
hospitals. Examples include acupuncture, chiropractic, and
massage therapy'(1993). Coverages vary widely among conventional
carriers, preferred providers as well as the omnipresent Health
Maintenance Organizations ('HMO'). The primary emphasis and, for
that matter, the only reason for the existence of insurance
companies is a single word, profit. More specifically, premiums
less costs provide the all important profit margin, the life
blood of the insurance industry. By not providing coverage for
the billion dollar industry of alternative treatments, insurance
companies are keeping the cost of the premiums down but at the
same time not allowing their customers to use complementary
treatments such as chiropractic to prevent or cure illness. The
more rigid and restrictive the policy provisos, the more
assurance for the companies that they will maximize their bottom
lines. Therefore, patients of alternative therapies as well as
doctors must show that such unconventional treatment provides
relief and prevention of illness. 'The total projected out-of-
pocket expenditure for unconventional therapy plus
supplements(such as diet pills and megavitamins)was 10.3 billion
dollars in 1990. This is comparable to the out-of-pocket
expenditure for all hospital care in the United States in
1990($12.8 billion), and it is nearly half the amount spent out
of pocket for all physicians' services in the United States($23.5
billion)'(nemj,1991). From this one may infer that society has
become fed up with inadequate results or side effects associated
with surgery and drugs which accompany the treatment of modern
medicine. So, in an effort to cope with the inadequate treatment
patients are receiving from conventional medicine, they are
seeking alternatives such as chiropractic for chronic illness and
pain. 'Although most doctors wince when you mention
chiropractors, some fairly rigorous studies have shown their
manipulations of the spine to be effective in relieving lower-
back pain. Orthopedic surgeons have even been known to refer
patients to chiropractors, and some 30 U.S. hospitals have
chiropractors on staff'(Wallis,1991).
Relevant Policies and/or Practices
'In 1997, 42 percent of all alternative therapies used were
exclusively attributed to treatment of existing illness, whereas
58 percent were used to prevent future illness from occurring or
to maintain health and vitality' (JAMA, 1998). 'The magnitude of
demand for alternative therapy is noteworthy, in light of the
relatively low rates of insurance coverage for these services'
(JAMA, 1998). Coverages vary widely depending on the policies
provided by the carriers. In my research, I contacted the Kern
County Superintendent of Schools, ('KCSOS'), Personnel Office to
inquire into the health policies provided to the nearly one
thousand employees of the office. There are a variety of options
available to each employee. The basic hospitalization plan used
by the majority of employees is the Blue Cross Prudent Buyer
Hospital Only plan. As required by State and Federal law, the
office is also required to make available approved HMO's if
employees request them. To that end, the office has a large
number of employees enrolled in Kaiser-Permanente and Health Net
HMO's. The administrative agency that provides the programs is
the Self Insured Schools of California, ('SISC'), which is a
cost-containment consortium of hundreds of California school
districts. Currently, SISC provides coverage for more than
thirty-five thousand employees and their eligible dependents. In
addition to medical coverages, the office also provides life,
vision, dental, prescription and mental and nervous policies.
The mental and nervous policy that is provided for each employee
and dependents is described as a 'carve-out' benefit. Prior to
this type of policy utilization, the basic Blue Cross medical
plan provided very specific and limited mental and nervous
benefits. Carve-out benefits provide coverages for treatments
that would not be covered otherwise. Several companies came
forward with plans that were more comprehensive and cost-
effective and replaced the medical plan component. An additional
benefit was that there was a net premium savings. Three
companies, Pacificare, MCC and BHA, offer plans at comparable
rates which provide a variety of family and personal counseling
services which are more along the lines of preventative medicine
rather than the hospitalization plans that were offered under the
basic hospitalization plan. Employee unions have been very
receptive to these plans due to the cost-containment provisions
as well as the intervention value for the employees that they
represent. For example, an employee with an alcohol or drug
addiction problem can get confidential assistance to assist in
the resolution of these problems and avoid being disciplined for
job performance problems.
The basic medical plans offered by the KCSOS office provide
various levels of coverage for several forms of alternative
medicine. The Blue Cross Prudent Hospital Only plan provides
coverage as follows: 'A doctor of medicine (M.D.) or a doctor of
osteopathy (D.O.) who is licensed to practice medicine or
osteopathy where the care is provided, or one of the following
providers, but only when the provider is licensed to practice
where the care is provided, is rendering a service within the
scope of that license, is providing a service for which benefits
are specified in this Plan Description, and when benefits would
be payable if the services were provided by a Physician as
defined above: a dentist, optometrist, dispensing optician,
podiatrist of chiropodist, psychologist, chiropractor,
acupuncturist(but only for acupuncture and for no other
services), certified registered nurse anesthetist, clinical
social worker*, marriage, family and child counselor*, physical
therapist*, speech pathologist*, audiologist*, occupational
therapist*, respiratory therapist*. Note: Services by the
providers indicated by asterisks (*) are covered only by the
referral of a Physician as defined above'(SISC III, 48).
'Health Net has partnered with American Specialty Health
Plans (ASHP) to offer Chiro Net quality, affordable
chiropractic coverage. With this program, you're free to
obtain this care by selecting a participating chiropractor
from the Chiro Net directory. Although you're always welcome
to consult your Primary Care Physician, you won't need a
referral to see a participating chiropractor.
What's covered
Office visits
$10 per visit
30 visits per year
There is a $50 annual chiropractic appliance allowance
toward the purchase of chiropractically necessary items such as
supports, collars, pillows, heel lifts, ice packs, cushions,
orthotics, rib belts and home traction units.
What's not covered
Limitations and exclusions
Air conditioners, air purifiers, therapeutic mattresses,
vitamins, minerals, nutritional supplements, durable medical
equipment, appliances or comfort items
Conjunctive physical therapy not associated with spinal,
muscle or joint adjustment
Diagnostic scanning, MRI, CAT scans or thermography
Exams or treatment of strictly non-neuromusculoskeletal
Hypotherapy, behavioral training, sleep therapy, weight
programs, educational programs, nonmedical self-help or
self-care, or any self-help physical exercise training
Lab tests, X-rays, adjustments, physical therapy or other
services not chiropractically necessary or classified as
Pre-employment physical or vocational rehabilitation arising
from employment or covered under any public liability
Treatment for temporalmandibular joint syndrome (TMJ)

Treatment or services not authorized by ASHP or delivered by
an ASHP provider
This is only a summary'(HealthNet, 7).
Nowhere in the Health Net coverage guide did it mention
coverage, limitation, or exclusion of the numerous treatment
modalities of alternative medicine except for chiropractic
treatment, which it supported in explicit detail. From this one
may conclude that chiropractic is the only alternative treatment
that has established a beneficial reputation in possibly
preventing illness and promoting wellness in the western world.
An extremist might say because Health Net does not include any
other forms of alternative medicine, that these modes of
treatment are not generally accepted by the medical community or
deemed effective or appropriate in treating illness.
Kaiser Permanente's coverage plan has a significantly larger
number of exclusions and limitations regarding treatment coverage
compared to Blue Cross and Health Net within the SISC
administrative agency. The exclusions section of Kaiser's
coverage guide states in section i, 'Chiropractic services and
services of a chiropractor,' which is in contrast to both Blue
Cross and Health Net, each of which fully recognize and provide
coverage for chiropractic services. In section j of the exclusion
section it seems that Kaiser is attempting to eliminate coverage
of all other alternative medicine treatment by stating,
'Experimental or Investigational Services and those procedures
not generally and customarily provided to patients residing in
the Service Area.'(Kaiser, 13) Their definition of Experimental
and Investigational Services is, 'any service or item that is not
recognized in accord with generally accepted medical standards as
being safe and effective for use in the treatment of the
condition in question, whether or not the service is authorized
by law for use in testing or other studies on human patients; or
any service requiring approval by any governmental authority
prior to use when such approval has not been granted prior to
provision of the service or item.' (Kaiser, 27) This seems to be
an attempt to classify all other forms of alternative medicine
treatments, with the possible exclusion of chiropractic, as
experimental forms of treatment. If this proves to be a
fallacious statement, by concluding that section j was an attempt
to deem that alternative medicine as an experimental service;
then one might conclude that Kaiser dismisses alternative
medicine treatment altogether by not including them in their
coverage plan at all. Either way Kaiser must view alternative
medicine as being inadequate or inappropriate treatment for
illness, providing relief of symptoms or improving their patients
degree of health.
Preventive medicine, wellness and alternative therapies are
fundamental components of a growing national trend. According to
a survey conducted by The Journal of the American Medical
Association, '...use of at least 1 of 16 alternative therapies
during the previous year increased from 33.8 percent in 1990 to
42.1 percent in 1997, and the probability of users visiting an
alternative medicine practitioner increased from 36.3 percent to
46.3 percent' (1998). More and more Americans are seeking options
other than conventional forms of medical treatment. Conventional
or modern medicine can be defined as treatment that is widely
accepted by U.S. medical schools and insurance companies as being
beneficial to the treatment of disease and illness with
scientific evidence. 'In 1993, the National Institutes of Health
chose Dr. Joe Jacobs to head their new Office of Alternative
Medicine. The office was created last year under pressure from a
Congress alarmed by the soaring cost of high-tech healing and the
frustrating fact that so many ailments such as: AIDS, cancer,
arthritis, back pain, which have yet to yield to standard
medicine'(Toufexis,1993). The cost of standard medical care has
risen dramatically. For example, a simple arthroscopic cartilage
repair on an outpatient basis costs in excess of five thousand
dollars for a thirty minute procedure. A simple Magnetic
Resonance Imaging, ('MRI'), costs over a thousand dollars. In
contrast, a visit to a chiropractor costs less than forty
dollars. The Journal of Occupational Medicine performed a study
comparing costs of treating back injuries with chiropractic and
traditional medicine. Using identical diagnostic codes for 3062
claims, the report reached the following conclusion: 'For the
total data set, cost for care was significantly more for medical
claims, and compensation costs were ten-fold less for
chiropractic claims.'(1991).

Major Position or Argument
Is it better to exercise preventive medicine rather than
focus on curing disease after the fact? In response, a growing
number of people have concluded that it is a quality of life
decision for them to opt for optimizing their health rather than
seeking cures. According to the study that represented the use of
unconventional therapy for the 10 most frequently reported
principal medical conditions, published in the New England
Journal of Medicine, '...a full third of the respondents who used
unconventional therapy in 1990 did not use it for any of their
principal medical conditions'(nejm,1991). From this fact we can
infer that a substantial amount of unconventional therapy is used
for non-serious medical conditions, health promotion, or disease
prevention. 'The probability that an individual patient who saw a
medical doctor also used unconventional therapy in 1990 was
higher than one in three for patients with anxiety(45 percent),
obesity(41 percent), back problems(36 percent), depression(35
percent), or chronic pain(34 percent), relaxation techniques,
chiropractic, and massage were the unconventional therapies used
most often in 1990" (nejm,1993). How can the insurance companies
ignore the fact that, 'an estimated number of ambulatory visits
to providers of unconventional therapy in 1990 was 425 million?
This number exceeds the estimated 388 million visits in 1990 to
all primary care physicians(general family practitioners,
pediatricians, and specialists in internal medicine) combined.
Also, if one assumes that charges for visits to providers of
alternative therapy were paid in full, Americans spent
approximately 11.7 billion dollars for these services in
1990"(nejm,1993). Nutrition stores have multiplied in the past
few years due to the growing demand for a variety of vitamins and
potions regarded by many as a viable means to fend off disease
and to improve on one's daily health. Additionally, fitness
centers and exercise facilities have sprung up ...

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