The Current State of Insurance Coverage for Acupuncture Therapy - Research Paper Example

Running header: Insurance Coverage for Acupuncture Therapy An Investigation of Factors Responsible for the Current of Insurance Coverage for Acupuncture Therapy Thesis: Insurance companies have been increasingly providing coverage for acupuncture treatments, on a selective basis, based on the effectiveness of treatments Abstract An increasing number of consumers are using acupuncture for treatment of diseases and disorders. However, the majority of insurance plans do not cover acupuncture causing hardship for patients. Insurance companies have been increasingly providing coverage for acupuncture treatments, on a selective basis, based on the effectiveness of treatments and acceptance. Introduction Acupuncture has its roots in China. The practice of acupuncture therapy spread to Japan, Korea, and other parts of Asia. Acupuncture has seen over 2500 years of development, with the ability to treat a wide range of diseases and conditions. Zhang (2003) described acupuncture as puncture using a needle. Acupuncture is often used with moxibustion - burning of selected herbs on the skin - and application of stimulation to certain points. Problem definition People have benefitted from complementary treatments including acupuncture in conjunction with their medical care. More and more people are using some form of complementary medicine. However, the effectiveness of acupuncture is viewed with scepticism in the West, where the foundation of health care is Western medicine. Questions regarding the true healing effect, placebo effect, enthusiasm of patients wishing for a cure, or the power of suggestion have continued to plague the approach. As the majority of insurance plans do not cover acupuncture therapy, paying for such treatments is a hardship for patients. According to experts, acupuncture therapy should be examined under controlled conditions, enabling determination of its effectiveness. Literature review Noertjojo and Martin (2003) found evidence from various studies (see table A-1 in Appendix A). The effectiveness for the treatment of temporary mandibular and dental pain and treatment of post-operative nausea and vomiting is strong. The evidence for the treatment of musculoskeletal disorders is not present. It has been established that acupuncture is relatively safe under competent practitioners. Noertjojo and Martin (2003) concluded that the benefits may not be experienced by all. Zhang (2003) argued that controlled clinical studies have established the effectiveness of acupuncture analgesia. Acupuncture analgesia is more effective than placebo comparable to morphine. Relief to pain in the eye caused by injection to subconjunctiva, post extubation pain locally (in kids), and thromboangiitis obliterans pain are effective. It is widely held that the use of acupuncture for treatment of chronic head pain or face could be significant. Acupuncture can alleviate pain and reduce muscle spasm, increasing muscle mobility. Conditions such as fasciitis; cervical spondylytis or neck pain; fibromyalgia; radicular and pseudoradicular pain; shoulder periarthritis; epicondylitis; low back pain; sciatica; and osteoarthritis with knee pain cold be treated with acupuncture. Acupuncture could treat rheumatoid arthritis, and its action on dysfunctional immune system or inflammation could be beneficial. Acupuncture is suitable for acute pain therapy including treatment of bilary and renal colic as an analgesic and antispasmodic. Acupuncture could relieve pain without the risk of drug dependence for traumas such as sprains. The analgesic effects of dental procedure postoperative pain are effective. Acupuncture analgesia can relieve labour pain, and could reduce labour duration. Acupuncture analgesia during surgical operations is safe, with no known adverse effects; and fewer post operative complications. Disadvantages associated with the use of acupuncture include time consumption; failure to bring about complete analgesia; unsuitability for suppression of visceral pain; and deft handling. Acupuncture is effective in the treatment of acute bacillary dysentery; could be used along with other therapies for infection treatment; treatment of pertussis; and treatment of common painful conditions such as headaches; migraines; and neuralgia. Beneficial effects have been observed for the treatment of acupuncture as a complement to rehabilitation. Acupuncture treatments are effective in the treatment of hemiplegia from cerebral haemorrhage. A summary of disorders have been illustrated in the table A-2 (see Appendix A). Analysis of the problem Chambers (2003) reasoned that plans for health insurance have resisted covering acupuncture therapy based on several factors. These include absence of strict oversight and regulation, and determination of which providers should be covered. These have been attributed to the inability to distinguish between legitimate treatments from “quackery.” Another reason was that plans for insurance have been developed by practitioners of Western medicine, and they have not allowed introduction of acupuncture in medical protocols. Recent years have seen progress, and many insurance plans have been providing varying degrees of coverage for acupuncture. Chambers (2003) found that there has been movement for provision of covering acupuncture therapy. However, coverage would be limited in many mechanisms. This includes provision of treatments by competent professionals. Regions licensing acupuncturists will be covered by insurance companies, but the therapy should be forwarded by a competent professional. A large number of hospitals and physicians have been incorporating acupuncture into their treatment regimen. In such settings, acupuncture treatments are likely to be covered by health insurance. The coverage would be like the cover for other therapies. Treatment by acupuncture has been excluded by Medicare. Coverage under the Medicaid program limits their benefits or requires provision of coverage for therapies in health care facilities. Possible solutions Devitt (2010) found that approximately sixty percent of US workers get benefits for health care from their employer, and the number of firms offering benefits for health care has been on a decline. Several reasons have been attributed for this. Drastic increase in premiums for insurance has been observed, with increases as much as 59 percent since 2000. Alternative and complementary medicine (ACM) has witnessed a move towards general health care. Benefits for different forms of ACM are being recognized by employers, and are being integrated into their existing insurance plans. The Kaiser Family Foundation and Health Research and Educational Trust reported that acupuncture cover by employers leaped 14 percent during 2002 to 2004. Acupuncture has emerged as the most favoured among ACM therapies for inclusion for coverage. Montgomery (2007) acknowledged that the benefits of alternative therapies are being recognized by some insurance companies. It could be highly effective in terms of cost to use alternative therapies regularly instead of conducting surgery, which is highly expensive and could be repeated later. Insurance firms have not been able to comprehend how these therapies could be used to maintain one’s well-being and health, and a lifestyle that is productive and functional. The majority of insurance companies would rather pay for surgery indicating that people would end up on disability and semi-functional list for the rest of their lives. Devitt (2010) found that the number of plans including cover for acupuncture therapy in comparison to other therapies have been on the rise. This has been attributed to more people seeking acupuncture therapy. Studies have validated effectiveness of acupuncture for treatment of several disorders such as dental and mandibular pain; nausea and vomiting post operation; and nausea and vomiting associated with chemotherapy. Evidence has also been found for the application of acupuncture therapy for treatment of chronic neck pain. Among the different forms of acupuncture, the majority of evidence has been for the use of needle. Growing awareness of acupuncture as an effective therapy for diseases and disorders has led people to seek acupuncture as a therapy for their ailments. Insurance providers are realizing the benefits of providing cover for acupuncture therapy. As the awareness increases, more people would seek acupuncture therapy. Consumers would seek plans that provide coverage for acupuncture therapy. In a competitive environment, insurance providers that do not provide coverage for insurance therapy would lose out to those providers that provide coverage for acupuncture. Employers are realizing that it may be cost effective to provide coverage for acupuncture. Some of the treatments require repeat visits, adding to costs. Acupuncture therapy could be highly cost effective in case of repeat treatments. The case for coverage of acupuncture is very good for consumers, insurance providers, and employers. It has been estimated that larger firms have a higher likelihood of covering acupuncture. This could be attributed to the availability of resources to complete the due diligence, and conduct cost-benefit analysis. Plan for implementation The American Medical Association (2009) has described the policy for insurance of health as an agreement between the provider and the consumer. When the premium has been paid, the health insurance company will make payments for covered medical care. However, the insurance company may not pay every bill and the consumer is responsible for payment of medical costs not covered by the health insurance company. One of the reasons for non payment of medical treatment is non coverage by the health insurance policy. Several therapies have proven effective and are sought by consumers. A well established system of practice for acupuncture would make it attractive for providers of insurance plans. The system must rely on rigorous training, registration and licensing of practitioners. This could be taken up at the state or the federal level. A reliable system would make it attractive to cover therapies that have already been proven effective. The Federal Acupuncture Coverage Act (HR 1479) plans to include acupuncture coverage under Federal Employees Health Benefits (FEHB) and Medicare. HR 1479 would require acupuncture therapy accepted in the group of benefits available in plans. Insurance providers would have to cover acupuncture therapy by licensed, registered, or certified acupuncturists. Approximately one out of four of FEHB plans offer acupuncture benefits. HR 1479 would provide acupuncture therapy by competent acupuncturists within plans (House.gov, 2007). Consumers, employers, and insurance providers acknowledge that acupuncture could be effective in the treatment of several disorders. Consumers feel that they could avail some relief for payments, when insurance providers cover acupuncture therapies. Insurance providers could gain advantage in terms of cost and competition by the provision of coverage. Employers could gain cost advantage by inclusion of plans that provide coverage for effective acupuncture therapies. Justification Thagard and Zhu (2001) argued that the linguistic, conceptual, and ontological differences between Chinese medicine and Western medicine are not insuperable for rational comparison. However, impediments arise from explanatory differences. Seeking explanatory coherence by Western researchers would be considered irrelevant by proponents of Chinese medicine. Biological and physiological studies give insight into the effects of acupuncture, but the practice of acupuncture is based on a separate model of balance in energy. However, it is widely being acknowledged that acupuncture could be useful in Western medicine. It is widely held that the conceptual differences between traditional Chinese medicine and Western medicine could be overcome. The extent of mutual comprehension depends on casual communication and intentional conceptual change. Proponents of each system must have adequate motivation to understand each other’s conceptual system for making any comparison and evaluation possible. This will allow each to adopt components of the alternative system by revising their own concepts. In order to achieve this the alternative system must be understood in terms of concepts, hypothesis, and evidence; translated into familiar terms; the alternative systems must be assessed for explanatory coherence and practical efficacy; and have the will to accept that the alternative system could be superior and worthy of replacement partially or totally. A major impediment is emotional attachment that people have to their own systems. However, earnest and intentional attempts can help overcome this. The National Institute of Health has held the view that acupuncture could be evaluated for its effectiveness, and piecemeal evaluation of particular treatments could be useful. Rational scientific evaluation of acupuncture is possible without a grand holistic clash of traditional Chinese medicine with Western medicine. The groundwork for the acceptance of acupuncture therapies for several disorders has been laid down by systematic reviews. Also, the framework for the practice of acupuncture has been discussed at the political level. Consumers and providers of insurance are looking for ways to incorporate acupuncture therapies into health plans. Conclusion Consumers generally pay for complementary and alternative medicine treatments such as acupuncture as out-of-pocket; or insurance. However, some plans for health insurance cover acupuncture treatments. When plans do cover acupuncture, the cover differs according to the state, and is restricted in the majority of cases. Consumers often need to know the first appointment cost; followup appointment cost; the number of appointments required for a condition; and additional costs involved. Consumers with insurance should know whether the provider accepts insurance; their experience with the insurance company; and how claims are to be filed. Health-care plans influence peoples lives. Policy decision makers are practically and ethically responsible for decisions, as the effects of policies are the significant way of determining how many policies do more benefit than harm. Oxman and Chalmers (2009) argued that health-care policies could be evaluated by random examination of health-care plans; results from non-random examinations of health-care plans; or treatment evaluations. Wilcox-Gök and Rubin (1994) found that a critical determinant of the decision to have insurance from private providers is dependent on health status and functional limitations, besides Medicare. Individual characteristics such as Medicaid; education; sex, race, age; household income; and employment influence the need for private health insurance. Hurd and McGarry (1997) found that the highly insured people use the most services. This could be attributed to incentivization of benefits associated with insurance. References Chambers, J. (2003). Health Insurance and Alternative/Complementary Medical Treatment. Retrieved from http://www.hcvadvocate.org/hepatitis/About_Hepatitis_pdf/1.1.1_Living_With_HepatitisC/CAM.pdf. Devitt, M. (2005). Report: Insurance Coverage for Acupuncture on the Rise. Retrieved from http://www.patriciakowal.com/Acu%20today.com%20insurance%20coverage.pdf. House.gov. (2007). Acupuncture Factsheet. Retrieved from http://www.house.gov/hinchey/issues/acupuncture_factsheet.pdf. Hurd, M. & McGarry, K. (1997). Medical insurance and the use of health care services by the elderly. Journal of Health Economics, 16(2), 129-154. American Medical Association. (2009). Understanding your health insurance policy and payment practices. Retrieved from http://www.ama-assn.org/ama1/pub/upload/mm/368/patient-flyer.pdf. Montgomery, K. (2007). Alternative Therapy Insurance Coverage. Retrieved from http://www.sportstouch.com/pdf_files/ALTERNATIVETHERAPYINSURANCECOVERAGE.pdf. NCCAM (2008). Paying for CAM Treatment. Retrieved from http://nccam.nih.gov/health/financial/D331.pdf. Noertjojo, K. & Martin, C. (2003). Acupuncture: Review of the Systematic reviews. Retrieved from http://www.worksafebc.com/health_care_providers/Assets/PDF/poster-presentations/acupuncture_review_systematic_reviews.pdf. Oxman, A & Chalmers, I. (2009). Fair tests of health-care policies and treatments: a request for help from readers. Retrieved from http://www.who.int/bulletin/volumes/87/6/09-066787.pdf. Thagard, P and Zhu, J. (2001). Acupuncture, Incommensurability, and Conceptual Change. Retrieved from cogsci.uwaterloo.ca/Articles/Pages/acupuncture.pdf. Wilcox-Gök, V. & Rubin, J. (1994). Health insurance coverage among the elderly. Social Science & Medicine, 38(11), 1521-1529. Zhang, X. (2003). Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. Retrieved from http://apps.who.int/medicinedocs/pdf/s4926e/s4926e.pdf. Appendix A: Tables Table A-1: Systematic Reviews (Noertjojo and Martin, 2003) Disease/condition Source of evidence Year Recommendation Acute Low Back Pain Swedish Council on TA 2000 No evidence Chronic Low Back Pain Swedish Council on TA 2000 Limited evidence Alberta Heritage Foundation HTA 2002 No evidence ICSI 2000 Limited evidence Acute Neck Pain Swedish Council on TA 2000 No evidence Chronic Neck Pain Swedish Council on TA 2000 Strong evidence against Alberta Heritage Foundation HTA 2002 No evidence Dental and Temporo-mandibular pain Alberta Heritage Foundation 2002 Strong evidence for NHS Centre for Review and Dissemination 2001 Evidence for Tinnitus Alberta Heritage Foundation HTA 2002 No evidence NHS Centre for Review and Dissemination 2001 Evidence for Post-operative nausea and vomiting Alberta Heritage Foundation HTA 2002 Strong evidence for HS Centre for review and Dissemination 2001 Evidence for Chemotherapy related nausea and vomiting Alberta Heritage Foundation HTA 2002 Evidence for NHS Centre for Review and Dissemination 2001 Evidence for Chronic pain Alberta Heritage Foundation HTA 2002 No evidence/inconclusive Ontario WSB 2001 No evidence/inconclusive NHS Centre for Review and Dissemination 2001 No evidence/inconclusive Fibromyalgia Alberta Heritage Foundation HTA 2002 No evidence/inconclusive Idiopathic headache Alberta Heritage Foundation HTA 2002 Inconclusive ICSI 2000 Limited evidence Osteoarthritis ICSI 2000 No evidence Lateral epicondylitis New Zealand HTA 2002 Inconclusive Patellofemoral pain syndrome New Zealand HTA 2002 Inconclusive Rotator cuff tendinitis New Zealand HTA 2002 Inconclusive Myofascial trigger point pain Cummings TM and White AR 2001 Inconclusive TA = Technology Assessment; HTA = Health Technology Assessment; ICSI=Institute for Clinical System Improvement Table A-2. Diseases and Disorders that can be treated by Acupuncture Therapy (Zhang, 2003) Diseases, symptoms or conditions for which acupuncture has been proved Diseases, symptoms or conditions for which acupuncture has been shown but further proof is required Acupuncture is worth trying as conventional and other therapies are difficult Acupuncture may be tried Adverse reactions to radiotherapy/chemotherapy; allergic rhinitis; biliary colic; depression; dysentery; dysmenorrhoea; epigastralia; facial pain; headache; hypertension; hypotension; induction of labour; knee pain; leucopenia; low back pain; malposition of fetus; morning sickness; nausea and vomiting; neck pain; pain in dentistry; periarthritis of shoulder; renal colic; rheumatoid arthritis; sciatica; sprain; stroke; tennis elbow Abdominal pain; acne vulgaris; alcohol dependence and detoxification; Bell’s palsy; bronchial asthma; cancer pain; cardiac neurosis; cholecystitis; competition stress syndrome; craniocerebral injury; diabetis mellitus; earache; epidemic haemorrhage fever; epistaxis; eye pain; female infertility; facial spasm; female urethral syndrome; fibromyalgia and fasciitis; gastrokinetic disturbance; gountry arthritis; Hepatitis B virus carrier status; Herpes zoster; Hyperlipaemia; Hypo-ovariansm; insomnia; labour pain; lactation; male sexual dysfunction; meniere disease; Neuralgia; neurodermatitis; obesity; opium, cocaine and heroin dependence; osteoarthritis; pain due to endoscopic examination; pain due to thromboangiitis obliterans; polycystic ovary syndrome; postextubation in children; post operative convalescence; premenstrual syndrome; prostatitis; prurits; pruritis; radicular and pseudoradicular pain syndrome; raynaud syndrome; recurrent lower urinary-tract infection; reflex sympathetic dystrophy; retention of urine; schizophrenia; siallism; sjorgen syndrome; sore throat; stiff neck; temporomandibular joint dysfunction; tietze syndrome; tobacco dependence; tourette syndrome; ulcerative colitis; urolithiasis; vascular dementia; pertussis Cholasma; choroidopathy; colour blindness; deafness; hypophernia; irritable colon syndrome; nuuropathic bladder in spinal cord injury; pulmonary heart disease; small airway obstruction Breathlessness in chronic obstructive pulmonary disease; coma; convulsions in infants; coronary heart disease; diarrhoea in infants and young children; encephalitis; paralysis; Read More