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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.