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The Cost of CAM

By Joanna Cosgrove | October 1, 2009

The uptick in complementary and alternative medicine spending prompts a closer look at CAM's place in the healthcare landscape.

Americans spent $33.9 billion out-of-pocket on complementary and alternative medicine (CAM) according to the results of a recently released government survey. A diverse array of medical and healthcare systems, practices and products, reported CAM expenditures spanned herbal supplements, meditation, chiropractic and acupuncture-treatments not generally considered to fall under the heading of conventional medicine. CAM accounted for approximately 1.5% of total healthcare expenditures ($2 trillion) and 11% of total out-of-pocket expenditures (conventional out-of-pocket: $287 billion and CAM out-of-pocket: $34 billion) on healthcare in the U.S.

Approximately 38% of adults used some form of CAM for health and wellness or to treat a variety of diseases and conditions, according to data from the 2007 National Health Interview Survey (NHIS). The CAM component of the NHIS was developed by the National Institutes of Health's (NIH) National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics (NCHS), part of the Centers for Disease Control and Prevention. The data provided estimates of the cost of CAM use, the frequency of visits made to CAM practitioners, and frequency of purchases of self-care CAM therapies.

"With so many Americans using and spending money on CAM therapies, it is extremely important to know whether the products and practices they use are safe and effective," commented Josephine Briggs, MD, director of NCCAM. "This underscores the importance of conducting rigorous research and providing evidence-based information on CAM so that healthcare providers and the public can make well-informed decisions."

Breakdown of Expenditures

Of the nearly $34 billion spent on CAM out-of-pocket, an estimated $22 billion was spent on self-care costs-CAM products, classes and materials-with the majority going to the purchase of non-vitamin, non-mineral, natural products ($15 billion) such as fish oil, glucosamine and Echinacea. U.S. adults also spent approximately $12 billion on an estimated 354 million visits to CAM practitioners such as acupuncturists, chiropractors, massage therapists, etc.

To put these figures in context, the $15 billion spent on non-vitamin, non-mineral, natural products is equivalent to approximately one-third of total out-of-pocket spending on prescription drugs, and the $12 billion spent on CAM practitioner visits is equivalent to approximately one-quarter of total out-of-pocket spending on physician visits.

"These data indicate that the U.S. public makes millions of visits to CAM providers each year and spends billions of dollars for these services, as well as for self-care forms of CAM," said Richard Nahin, PhD, MPH, acting director of NCCAM's Division of Extramural Research and lead author of the cost of complementary and alternative medicine analysis. "While these expenditures represent just a small fraction of total healthcare spending in the United States, they constitute a substantial part of out-of-pocket healthcare costs."

The Place for CAM

To Michael McGuffin, president of the American Herbal Products Association, Silver Spring, MD, the survey data indicate an evolving belief about the responsibility to be involved in one's own healthcare choices, whether it's utilizing conventional doctors, alternative treatments or a blending of the two. But solidifying the role of CAM within the U.S. healthcare system is at least "15 years" from being addressed in the proper context, he said.

Despite the ongoing dialogue about our healthcare system, Mr. McGuffin argued that the heated town hall meetings and legislative bickering is less about healthcare policy reform and more about health insurance policy. "(The CAM data) is significant, but we are not yet engaged in a conversation about healthcare reform," he said regretfully. "There are some details in some of the bills that have emerged that at least imply a discussion of healthcare reform, but most of the ink is about how we can get more people covered by health insurance, how we can change health insurance so they won't drop people when they get sick, etc. Those are the real topics."

He added that the best way to realistically and effectively incorporate CAM into the realm of insurance coverage would be to attack the issue of healthcare on two levels. "I don't mean to be overly pessimistic but I don't mind being, in a sense, overtly critical and somewhat concerned that some piece of legislation will pass and then we'll think we've reformed healthcare. And that's too bad because the opportunity would then be missed," he said. "I wish this had been rebranded right at the beginning as health insurance reform that carried a corollary that said we'd later talk about healthcare reform.

"The whole discussion of healthcare relies on prevention and health maintenance," he added. "In the world of conventional medicine, the significant element of prevention is vaccination. They talk about diet and exercise but it's not inherent in our healthcare system. We don't have systems in place where the medical system actively encourages good health maintenance."

Although the concept of an improved healthcare system that offers both facets of care isn't currently on the table, Mr. McGuffin felt that the early groundwork is being laid. "I have heard Senator Tom Harkin (D-Iowa) say we don't have a healthcare system; we have a disease care system. In stating that, he's indentifying what he considers to be a problem," he said. "During Obama's campaign, I read his health policy statement and he repeated that exact statement."

He also pointed to the potential embodied in the hearing held earlier this year by the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) called "Integrative Medicine: A Pathway to a Healthier Nation," which was co-chaired by Senators Harkin and Barbara Mikulski (D-Maryland). "The conference was marked by presentations from the nation's most reputable alternative care authorities and there was a moment when Sen. Harkin said something to the effect of 'It's amazing what you know and have shared with us. Now what do we do? What can we do legislatively that can transform the health of Americans?'" remarked Mr. McGuffin.

The overarching goal as it relates to alternative care, he said, is to eliminate the term "alternative" altogether. "To me, that $34 billion is money spent on healthcare, even though it was cast as money spent on alternative medicine," he said. I don't mean to castigate conventional medicine or glorify alternative medicine, I do think there are some tendencies associated with both of those: the people who are spending the money on alternative care tend to be adults who understand they have some personal responsibility for maintaining their health and they see alternative tools that can help them in maintaining their health.

"The goal is to no longer see dietary supplements and treatments like acupuncture as 'alternative.' The vision has to be that we so understand the value of these things that they are no longer as secondary or experimental. It ought to be the norm that you can take care of your health before you get sick and that you recognize that there are non-invasive treatments like acupuncture that are brilliant at balancing before you get sick."

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