Complementary services: Consumer demand outpaces research, insurance
Americans are demanding complementary medicine services even before researchers can evaluate them or insurance companies can figure out how to bill for them, concludes a Stanford psychologist who has studied insurance coverage of such services.
"We need something as simple as appropriate billing codes [CPT] for various complementary services before we can even begin to track and conduct extensive research on whether these new techniques ... are indeed effective," said Kenneth R. Pelletier, clinical associate professor of medicine.
"Providers of complementary sometimes referred to as alternative medicine need to develop standards of practice and licensing which will help them to fit into the existing diagnosis-based system," Pelletier said. "Offering a clinic at Stanford [see accompanying article] should be a big help in finding ways to 'codify' standards for this area of medicine."
Of the 18 representative U.S. insurance companies he and his colleagues surveyed, 12 offered some coverage for various complementary services, including nutrition counseling, biofeedback, psychotherapy, acupuncture, preventive medicine, chiropractic, osteopathy and physical therapy. Decisions on what to cover tended to be based primarily on consumer demands for such services, the researchers found.
The results of the study were published last December in the American Journal of Health Promotion.
Pelletier noted that the Stanford Center for Research in Disease Prevention (SCRDP) is embarked on a four-year, $1.2 million research effort to study various complementary treatments that might enhance life for people older than 55. The research is funded by a 1995 grant from the NIH Office of Alternative Medicine.
One component of the SCRDP effort is to learn whether certain plant substances, such as soy protein and flax seed, can replace or supplement synthetic estrogen therapy to reduce symptoms of menopause. The researchers, led by Pelletier and William A. Haskell, professor of medicine, are also looking at the use of t'ai chi to improve balance, autonomic nervous system function and psychological well-being among older women and men. Stanford is one of 11 sites in the NIH initiative.
Pelletier's insurance survey, a separate study funded by the National Institute of Arthritis and Musculoskeletal and Skin Disorders, indicated that the current U.S. demand for complementary and alternative medicine comes largely from middle-aged and older individuals, as well as sufferers of chronic and/or difficult-to-treat illnesses, who are investing to improve their health and who often spend their own money for treatments when insurance is not available.
"Five surveys conducted since 1990 [by various research teams around the country] report frequent use of CAM [complementary and alternative medicine], ranging from 30 to 75 percent, by patients suffering from conditions such as cancer, arthritis, acquired immunodeficiency syndrome, multiple sclerosis and acute back pain," Pelletier and his colleagues observed in their research paper.
"Use of CAM does not significantly vary by gender or insurance status, but use is more frequent for highly educated, high-income, nonblack Americans who live in the western U.S.," the authors said.
Pelletier's co-authors included
Haskell, former research assistant Ariane Marie and former
undergraduate student Melissa Krasner. -- M.G.