NZCA Welcomes Call For Wider Funded Access To Chiropractic Care

The New Zealand Chiropractors’ Association (NZCA) welcomes the call in a major new report by the New Zealand Institute for Economic Research (NZIER) for publicly funded access to chiropractic care for spinal and neural conditions to be made available to New Zealanders with chronic conditions.

The report “Hidden In Plain Sight: Optimising the allied health professions for better, more sustainable integrated care” was commissioned by Allied Health Aotearoa New Zealand.

Among the NZIER’s wide-ranging recommendations for a greater role for allied health professions in improving the health and wellbeing of New Zealanders, the report highlights that chiropractic could have a greater impact if extended to populations with chronic conditions but these groups are generally least able to afford private care. It calls for chiropractors in publicly-funded roles, which could improve the cost-effectiveness of tier 1 care teams by providing equitable access to high-quality care.

NZCA spokesperson and chiropractor, Dr Jenna Duehr explains: `The report warns that we are facing a rising burden of neuromusculoskeletal conditions – including low back pain and acute and chronic spinal and neural conditions. Evidence is mounting to support the positive impact chiropractic can make particularly for geriatric, paediatric and neuro-atypical populations. This includes injury management and prevention, supporting function in degenerative conditions, and reduction of falls risk in the elderly through increased joint proprioception and enhanced neurological integration.’

NZIER Recommendations

The report says that increased access to chiropractic care can support a more person-centred, equitable, high quality and cost-effective integrated health and disability system. To address the critical barriers and enable an optimal use of chiropractors, NZIER recommends the following changes:

Address professional, governance, funding and payment barriers to increased collaborative interdisciplinary care in tier 1 settings with specific mechanisms to support publicly-funded access to chiropractic care.

Empower clinicians with better information about the role and potential benefits of chiropractic care to support professional trust.

Improve referrals to chiropractic care through referral protocols for use by GPs and other allied health practitioners.

The report also stressed

The rising burden of mild to moderate mental health issues – including anxiety and depression and the relationship to sedentary lifestyle, posture, tension and nervous system function.

Postural conditions and overuse syndromes which are becoming common in younger people due to use of handheld technology (e.g. tech-neck) and in the management of adolescent scoliosis.

The need for education and lifestyle advice regarding postural, spinal and lifestyle factors that can improve overall health and wellbeing.

Jenna Duehr adds: `This important report confirms our long-held view that greater access to chiropractic care within hospitals and aged residential care would provide more effective care and better patient experiences within these settings where neuromusculoskeletal conditions, spinal and neural conditions, and mental health issues are common.’

According to the NZIER chiropractic input is currently sub-optimal due to:

A lack of publicly-funded roles for chiropractors.

Existing primary care ownership and governance models that favour GP professional dominance and reinforce staffing models in which allied health are seen as an unnecessary cost.

Primary care payments that are insufficient to cover the full cost of interdisciplinary care for people with chronic conditions and do not reward integrated tier 1 teams for achieving good outcomes.

A lack of understanding of the capabilities and skills of chiropractors within the health and disability system and misconceptions around safety and efficacy.

The lack of any mechanism to support patient choice which denies some patients the ability to seek chiropractic care.

Further Information

Evidence base

An analysis of the 4-year service utilisation and health care costs of people using chiropractic and other alternative medicine providers had 43% fewer hospital admissions, 58% fewer hospital days, 43% fewer outpatient surgeries and procedures and 52% lower medication costs compared with those who used conventional primary care only[1].

An extension to 7 years of follow-up on the above study confirmed the longer-term cost-effectiveness of chiropractic and alternative medicine approaches in identifying that the same group continued to demonstrate 60% fewer hospital admissions, 59% fewer hospital days, 62% fewer outpatient surgeries and procedures, and 85% lower medication costs compared with those who used conventional primary care only[2].

Markov-modelling of 22 non-pharmacologic interventions for chronic low back pain compared to usual care alone showed that most interventions, including spinal manipulation, exercise and manipulation, chiropractic care and multidisciplinary programmes, are cost-effective or cost-saving when health care and productivity costs are included[3]. This result is consistent with numerous studies demonstrating that chronic low back pain has significant social and economic costs.

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