Highlights
- •Willingness to pay for a 1-point reduction in chronic back pain was $45.98 per month.
- •Willingness to pay for a 1-point reduction in chronic neck pain was $37.32 per month.
- •These estimates met a variety of validity checks including downward-sloping demand.
- •Patients reported that their pain would be higher without chiropractic visits.
- •Comparing stated WTP with visit costs indicates patients pay to avoid this higher pain.
Abstract
Many recommended nonpharmacologic therapies for patients with chronic spinal pain
require visits to providers such as acupuncturists and chiropractors. Little information
is available to inform third-party payers’ coverage policies regarding ongoing use
of these therapies. This study offers contingent valuation-based estimates of patient
willingness to pay (WTP) for pain reductions from a large (n = 1,583) sample of patients
using ongoing chiropractic care to manage their chronic low back and neck pain. Average
WTP estimates were $45.98 (45.8) per month per 1-point reduction in current pain for
chronic low back pain and $37.32 (38.0) for chronic neck pain. These estimates met
a variety of validity checks including that individuals’ values define a downward-sloping
demand curve for these services. Comparing these WTP estimates with patients’ actual
use of chiropractic care over the next 3 months indicates that these patients are
likely “buying” perceived pain reductions from what they believe their pain would
have been if they didn't see their chiropractor—that is, they value maintenance of
their current mild pain levels. These results provide some evidence for copay levels
and their relationship to patient demand, but call into question ongoing coverage
policies that require the documentation of continued improvement or of experienced
clinical deterioration with treatment withdrawal.
Perspective
This study provides estimates of reported WTP for pain reduction from a large sample
of patients using chiropractic care to manage their chronic spinal pain and compares
these estimates to what these patients do for care over the next 3 months, to inform
coverage policies for ongoing care.
Key words
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Article info
Publication history
Published online: May 06, 2019
Accepted:
May 2,
2019
Received in revised form:
April 2,
2019
Received:
January 1,
2019
Footnotes
This work was supported by the National Center for Complementary and Integrative Health of the National Institutes of Health [grant number 1U19AT007912-01]
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2019 by the American Pain Society
