The Current Fiscal Crisis

Pran Manga, PhD, M. Phil and Don Nixdorf, DC
February 03, 2011
Written by Pran Manga, PhD, M. Phil and Don Nixdorf, DC
The economies of western nations continue to be characterized by debt, deficits and desperate solutions. Most of them now have the worst levels of unemployment since the Great Depression. With low growth rates, the prospect of rapid change is nil to small. Most nations are looking to monetary solutions, where more money is being printed to lend cover for past and current spending.

This grim economic and fiscal picture may hold unprecedented opportunities for chiropractic. Why? A renewed emphasis on cost-cutting and cost-effectiveness has already begun and the profession is perfectly equipped to respond to this.

Almost everywhere, the current fiscal crisis threatens health-care programs and insurance (especially public) plans. Governments can no longer simply throw more money in the health-care pot, and appease the monopolies heretofore retained by such powers as medical doctors, dentists and pharmaceutical corporations. Up to now, governments have all but cowered before these groups, and thus were reluctant to make substantive health-care reforms – indeed the more significant the reforms, the more reluctant they have been – pushing marginally important reforms merely as window dressing. Worse, they undertook counterproductive reforms such as cutting chiropractic coverage and benefits from their insurance plans. Accountability for this activity has not been required – governments are not required to show that such cuts were sensible and worthwhile.

Both Canada and the United States are engaged in addressing their economies and funding schemes for health care. Canada is currently engaged through the provincial-federal discussions and is likely to alter the Canada Health Act. (The resulting document will become the “2014 Canada Health Accord”). The United States continues its legislative battles intended to provide various levels of insurance for uninsured Americans. Whether we examine the 2014 Canadian accord, or the eventual U.S. legislation reform, we find that both simply increase the supply of money being spent on existing health-care strategies – whether this results in something like the quantitative easing of past mistakes through bailouts remains to be seen. We think not and expect better. Both countries now seem to recognize that an efficient heath-care system is integral to their economic success in a highly globalized and competitive world economy.

Chiropractic represents a major opportunity for provinces and states alike to reduce a major contributor to growing annual government budgets. These are primarily provincial budgets in Canada but both federal and state budgets in the United States. But, since all governments are facing dire fiscal stress, we need to aim at influencing both levels of government, granted with a more concerted focus on provincial governments because they feel the rising health-care expenditures more acutely and immediately than does the federal government.

We do not detail here what our case can be based on, since this is well known and has been repeated many times and in various venues and sources. It is sufficient to say there is abundant evidence in favour of pushing for reform that involves chiropractic.

EXTENDING PRIMARY HEALTH-CARE DESIGNATIONS
We do think it is time to stress that we can relieve the burden on the system by being recognized and utilized as primary health-caregivers. Shifting a cohort of patients from medical doctors to chiropractors will yield the health benefits documented in the extant studies, while immediately increasing the supply of medical doctors available to address other health-care needs and having a major effect on wait times for care. Indeed, and similarly, freeing up medical doctors may also be attained by allowing a greater scope of practice for nurse practitioners – both initiatives have massive and immediate payoffs. However, the truth is the system cannot be reformed significantly unless we, as a society, get away from the anachronistic notions that support mainstream medicine’s dominant hold on the health-care turf, and its role as the sole gatekeeper. The authors suggest that increasing the numbers of groups considered as primary health-caregivers is a truly revolutionary change and will have salutary consequences on virtually all aspects of the health-care system. The expansion of primary care is supported by government statements, including one by former Minister of Health, George Abbott: “The greatest untapped resource in health care is the consumer. Well-informed patients get better care from their doctors and provide better care for themselves. The issue at hand is to get the right information into the hands of the right person at the right time.”

CHIROPRACTIC SAVES MONEY
The enormous cost of health care in the United States and Canada constitutes an opportunity to identify strategies for real and immediate annual savings that contribute to economic recovery and sustainability. In order for these strategies to be considered as valid and helpful, they must demonstrate two basic and essential attributes inherent to other goods or services sectors that are acknowledged and practised – namely, effectiveness and outcomes.

The chiropractic profession is a leader by example, with unparalleled findings of facilitating fiscal stability and benefits for patients’ well-being that governments and public alike can rely upon. Little time need be spent on authoring new studies. Instead, members can simply update the data of previous studies to reflect 2010 fiscal values to engage media and public alike regarding the benefits to patients and the economy.

For instance, if we scale up the savings calculated by Manga and Angus in 1998 to 2010 proportions, by the rate of inflation alone, we are looking at annual savings, in Canada, in the ballpark of $4 billion dollars from substituting chiropractic for medical care of musculoskeletal conditions! This does not include other benefits of substituting chiropractic for other types of care for musculoskeletal conditions!

As James Carville, the American political strategist, voiced, “It’s the economy, stupid.” Indeed, along with the well-documented Canadian studies on cost savings, American health-care data equally documents substantial cost savings when chiropractic is included in health-care strategy. In 2002, Donald Muse, of Muse and Associates, reported an analysis of Medicare and Medicaid patients who included chiropractic in their health-care and showed annual health costs of $4,400 compared to $8,100 per year for patients without chiropractic.

The chiropractic profession, through individual doctors as well as provincial associations’ initiatives, can “take the stage” to advance discussion and formulate submissions – repeatedly, if necessary – to all levels of health authority, employers, and the public, on the substantive annual reduction in health costs that could be attained by including chiropractic in health-care strategies.

MORE REASONS TO CONSIDER CHIROPRACTIC
Improvements in safety of health care alone could contribute enormously to the economy. In Canada, the annual loss-of-life due to preventable medical mistakes is 24,000 per year, and in the United States, this figure is 100,000 per year.

Spine and related conditions represent an estimated one-third of all daily office visits to physicians in both countries. Effectiveness and positive outcomes of these could be realized from appropriate diagnosis and treatment. The chiropractic profession has increasingly been acknowledged to be among the safest form of care that also provides optimum outcomes.

The provincial, state, and federal economic emergencies that have constituted our current fiscal crisis, along with existing legislative initiatives, provide the chiropractic profession the opportunity, and the responsibility, to focus on delivering information that will both contribute to economic solutions, and improve the health of the population. Chiropractic doctors and their provincial initiatives must not waste this current opportunity and must be bold and forthright with the fiscal ideas for reform. It will be important to focus on the benefits to the population as a whole and the amelioration of the current economic crisis we are facing. Making alliances with other health-caregivers is also very important because, politically, there is strength in numbers.

Finally, fighting for reform that benefits the economy and public health, now, will also add measureably to chiropractic identity and unity.

Dr. Pran Manga is presently a professor in the Telfer School of Management at the University of Ottawa. He is the author or co-author of many articles, monographs and books on health economics, health policy and bioethics. He has held senior positions with both the federal and the Ontario governments, and has contributed to several Royal or similar commissions of inquiry.

Dr. Don Nixdorf has been the executive director of the BCCA since 1985, was BCCA and BCCC president from1982-1985, governor and secretary-treasurer of the CCA from 1987 to 1989  and served as chair of the Commission on Chiropractic Education (Canada) from 1994 until 1999. From 1982-1991 he was staff chiropractor/consultant to the Workers’ Compensation Board of B.C. and has been a participant in National E-Claims Standards since 2001. He is a former committee member of the BC government Health Information Standards Council.  Dr. Nixdorf is also co-author of Squandering Billions: Health Care In Canada, which analyzes the causes of the crisis in health care and strategies for its survival. He can be contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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