Current Trends in the Integration and Reimbursement of Complementary and Alternative Medicine by Managed Care, Insurance Carriers, and Hospital Providers

Kenneth R. Pelletier, Ariane Marie, Melissa Krasner, William L. Haskell

Research output: Contribution to journalArticlepeer-review

107 Scopus citations

Abstract

Objectives. To assess the status of managed care and insurance coverage of complementary and alternative medicine (CAM) and the integration of such services offered by hospitals. Methods. A literature review and information search was conducted to determine which insurers had special policies for CAM and which hospitals were offering CAM. Telephone interviews were conducted with a definitive sample of 18 insurers and a representative subsample of seven hospitals. Results. A majority of the insurers interviewed offered some coverage for the following: nutrition counseling, biofeedback, psychotherapy, acupuncture, preventive medicine, chiropractic, osteopathy, and physical therapy. Twelve insurers said that market demand was their primary motivation for covering CAM. Factors determining whether insurers would offer coverage for additional therapies included potential cost-effectiveness based on consumer interest, demonstrable clinical efficacy, and state mandates. Some hospitals are also responding to consumer interest in CAM, although hospitals can only offer CAM therapies for which local, licensed practitioners are available. Among the most common obstacles listed to incorporating CAM into mainstream health care were lack of research on efficacy, economics, ignorance about CAM, provider competition and division, and lack of standards of practice. Conclusions. Consumer demand for CAM is motivating more insurers and hospitals to assess the benefits of incorporating CAM. Outcomes studies for both allopathic and CAM therapies are needed to help create a health care system based upon treatments that work, whether they are mainstream, complementary, or alternative.

Original languageEnglish (US)
Pages (from-to)112-123
Number of pages12
JournalAmerican Journal of Health Promotion
Volume12
Issue number2
DOIs
StatePublished - 1997

Keywords

  • Alternative Medicine
  • Complementary Medicine
  • Disease Management
  • Health Promotion
  • Hospital
  • Insurance
  • Managed Care
  • Providers
  • Reimbursement

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health

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