By: Rachel Boldt
Our second reform proposal for outpatient and primary care requires Congress to take action to mandate the integration of researched-based methods of complementary and alternative medicine (CAM) with current insurance covered, conventional medicine services. CAM is defined by the National Center for Complementary and Alternative Medicine (NCCAM) as “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.” CAM therapies incorporate a large spectrum of treatment options like, “homeopathy, herbal formulas, use of other natural products as preventive and treatment agents, acupuncture, meditation, yoga exercises, biofeedback, and spiritual guidance or prayer…chiropractic care is also largely regarded as a complementary treatment” (Shi and Singh, p. 274). Treatments are frequently undergoing research, which impacts what is used and considered to be alternative medicine (Mayo Clinic). “Complementary medicine” refers to the use of an alternative medicine therapy with conventional therapy, and “integrative medicine” refers to the use of a complementary therapy with a conventional one (Mayo Clinic).
The use of CAM practices is on the rise in the U.S., with 40% of adults reportedly using them (Mayo Clinic). Typical causes for these alternative therapies “were back problems, allergies, fatigue, arthritis, and headaches” (Shi and Singh, p. 275). Most people have to pay for CAM services and products out-of-pocket, and when health insurance companies do offer coverage, it varies by state and is often limited (NCCAM). Americans spend more than $34 billion per year out-of-pocket on CAM therapies (BMC Complementary and Alternative Medicine, 2005). Results of studies from BMC Complementary and Alternative Medicine (2005) focusing on the economic evaluation of CAM therapies show many to be cost-effective compared to conventional care, including: “acupuncture for migraine, manual therapy for neck pain, self-administered stress management for cancer patients undergoing chemotherapy, biofeedback for patients with ‘functional’ disorders (eg, irritable bowel syndrome), and guided imagery, relaxation therapy, and potassium-rich diet for cardiac patients” (BMC Complementary and Alternative Medicine, 2005). As this study demonstrated, certain CAM therapies would provide cost-effective alternatives to conventional care. Certain CAM therapies cost less and, depending on the patient, may be more effective, resulting in decreased cost and improved outcomes than comparable conventional methods.
Standard conventional physician training does not include CAM therapies, thus they may not be capable to recommend or address concerns regarding them (Mayo Clinic). Under our reform proposal, research based methods of CAM would be integrated into the health care system and covered under all health insurance plans. As a result, primary care physicians would see greater need and incentive to become more knowledgeable on CAM therapies. This may lead to greater utilization, referral, and access to research based CAM therapies.
There are different treatment methods used within complementary medicine, but the reoccurring theme among them is to “treat the patient as a whole person rather than treating a specific symptom or symptoms” (Institute for Complementary and Natural Medicine). David Rakel, M.D., founder and director of the University of Wisconsin Integrative Medicine Program and an assistant professor in the department of family medicine at the UW School of Medicine and Public Health, believes in directing individuals to become healthier through the understanding of “their bio, psycho, social, spiritual uniqueness.” He stresses the importance of taking time to hear each individual’s story, as being a good listener “allows for more efficient health care decisions and really gets at the root of healing” (Dr. Rakel, UW Health). These practices can have a positive impact on quality. Treating the patient as a whole and allowing them the option to use methods of CAM would increase satisfaction and efficiency. This results in patients’ specific needs and values being incorporated into their plan of care development and implementation, and improving the patient and physician relationship.
CAM is important because it takes a holistic approach, not just focusing on current symptoms, but on all areas of a patient’s health and well-being. Some believe CAM is less important than conventional medicine because it is not highly regulated and the effectiveness and safety of some treatments have not been evaluated through scientific studies (Shi and Singh, p. 275). However, recently there have been prominent advances in CAM research. NCCAM is the lead agency for scientific research on CAM (NCCAM). Funds for the center have risen from $2 million in 1993 to $122.7 million in 2006 (Shi and Singh, p. 275). The focus of NCCAM is to research and scientifically evaluate CAM practices, and to effectively report their findings (NCCAM). This coincides with an increasing number of medical schools in the U.S. offering some instruction in alternative medicine (Shi and Singh, p. 275).
References (APA):
Herman, P. M., Craig, B. M., & Caspi, O. (2005). Is complementary and alternative medicine (CAM) cost-effective? A systematic review. BMC Complementary and Alternative Medicine, 5(11). doi:10.1186/1472-6882-5-11.
Institute for Complementary and Natural Medicine. (n.d.). What is complementary and alternative medicine (CAM)? Retrieved March 12, 2010, from http://www.i-c-m.org.uk/about/complementary
Mayo Clinic staff. (2009, October 24). Complementary and alternative medicine: What is it? Retrieved March 14, 2010, from http://www.mayoclinic.com/health/alternative-medicine/PN00001
National Center for Complementary and Alternative Medicine. (2007, February). Complementary and alternative medicine. Retrieved March 12, 2010, from http://nccam.nih.gov/
Shi, L., & Singh, D. A. (2008). Delivering health care in America: A systems approach (4th ed., pp. 274-275). Sudbury, MA: Jones and Bartlett Publishers.
UW Health – University of Wisconsin Hospital – Madison, (2008, February 14). David P. Rakel, MD, [Video profile]. Retrieved March 14, 2010, from http://findadoctor.uwhealth.org/findadoctor/profile.jsp?provider=7215
I like the reform proposal. Not only does this suggest a great way for changes to take place, but it addresses nearly all of the complications in out-patient care. I like the idea of covering more things under the insurance plans available to people.
ReplyDeleteI liked the paragraph addressing the importance of a person as a "whole". Referring to a person as a "whole" has got to be taking into consideration with each and every procedure that a doctor performs. If every doctor shared this same view it would have a positive impact on quality.
The purpose of your initiative states that you want Congress to support the implementation of researched based CAM interventions to be used along with traditional western medicine. However what, if any, research support is there currently for the various CAM therapies?
ReplyDeleteIn my opinion the research there is out there is minimal at best. This is detrimental to this initiative because any insurance reimbursement requires the treatment to have research evidence supporting its use. Medicare's reimbursement standards, which most private insurance companies also follow, require that an intervention be both reasonable and necessary, as well as having proven research support of its effectiveness. Thus before any CAM interventions becomes mainstream and utilized by the medical system there must be unbiased research, not studies done by CAM advocating groups, or else CAM will not be reimbursable by insurance and thus impractical to implement through any system other than out-of-pocket.
While I agree this initiative would be a good thing to have pass because some CAM therapies do sound beneficial and the principles they are based upon make sense, quality randomized control trials are needed before anything like this will ever be passed by Congress.
I like the idea of integrating CAM into conventional insurance policies. I think that it could lead to an increase in the quality of our health care.
ReplyDeleteOne concern I do have is who would be practicing CAM. I believe some would be by doctors, but how do you decide something like what yoga class would be covered by insurance? It seems like there'd have to be a certification or licensure of some sort.
I do think that this proposal to reform could increase jobs for those in areas of CAM, which would be a benefit, especially as the utilization of CAM has been increasing in the U.S.
This is an interesting idea, and I would definitely agree that alternative approaches to medicine could be very beneficial and could even help to reduce overall cost of health care by increasing prevention and decreasing use of prescription medications. On the other hand, I can see how a lot of Americans may be skeptical if some alternative methods to medicine are really effective and worth their tax dollars. It would be very important to have sufficient research to back up this proposal as well as detailed information about what services are to be covered in order to stand a chance at passing. Overall, a great idea though, and I totally agree that CAM should be used more in the US, especially for chronic conditions!
ReplyDeleteI LOVE the idea of incorporating CAM into our current healthcare practices. Its very frustrating when your insurance provider is more than willing to provide coverage for prescription drugs that just mask or manage the problem, but in my case will only cover 10 visits per year for chiropractor, PT, etc., which could actually get rid of, prevent, or significantly help the problem. However I agree with Andrew that this may be wishful thinking because its hard to prove its effectiveness.
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