According to a new report based on a government survey in 2007, in the previous 12 months Americans had spent a total of $33.9 billion out of their own pockets on complementary and alternative medicine (CAM).

The report was compiled by Dr Richard L. Nahin of the National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM) and colleagues and was published in the 30 July issue of the US Centers for Disease Control and Prevention (CDC) National Health Statistic Report.

For the purpose of the report, CAM was defined as a diverse group of medical and health care systems, practices and products that are not generally considered to be part of conventional medicine: for instance herbal supplements, chiropractic, acupuncture and meditation.

According to sources cited by a recent National Institutes of Health press release, CAM accounts for around 1.5 per cent of the $2.2 trillion that the US spends on healthcare every year, and around 11.2 per cent of out-of-pocket expenditures (where people pay for it themselves as opposed to the state or insurance scheme).

For the report, Nahin and colleagues used data from the Complementary and Alternative Medicine Supplement of the 2007 National Health Interview Survey (NHIS), which is conducted by the CDC’s National Center for Health Statistics.

The survey data came from 3,393 completed interviews with sample adults aged 18 years and over.

The authors used a statistical software package called SUDAAN to calculate estimates and standard errors. The package is designed to tackle the sample complexity of surveys like the NHIS so that the results are reprensentative of the US civilian, noninstitutionalized population aged 18 years and over.

The results showed that in 2007:

  • Adults in the US spent a total of $33.9 billion out of pocket to visit CAM practitioners and buy CAM products, classes and materials.
  • Nearly two-thirds of this total went on self-care purchases of CAM products, classes and materials ($22.0 billion).
  • The remaining third ($11.9 billion) was spent on practitioner visits.
  • Despite the greater amount spent on self-care therapies, 38.1 million adults made an estimated 354.2 million visits to CAM practitioners.
  • About three quarters of the total number of CAM practitioner visits and out of pocket expenditure on CAM practitioners was linked to manipulative and body-based therapies.
  • 44 per cent of the total out of pocket expenditure on CAM (about $14.8 billion) was spent on nonvitamin, nonmineral, natural products.

To put these figures in to context, £14.8 billion spent on spent on nonvitamin, nonmineral, natural CAM products is about one third of the total out of pocket expenditure spent on prescription medicine. And the $11.9 billion spent on seeing CAM practitioners is about one quarter of the total out of pocket expenditure spent on visiting “conventional” physicians.

Nahin, who is acting director of NCCAM’s Division of Extramural Research, told the media that:

“These data indicate that the US 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.”

“While these expenditures represent just a small fraction of total health care spending in the United States, they constitute a substantial part of out-of- pocket health care costs,” he added.

While there is no previous exact survey with which comparisons can be made, the authors did discuss how these results compare with a broadly similar survey covering much the same set of CAM therapies that was done about 10 years ago by DM Eisenberg and colleagues and published in the Journal of the American Medical Association in 1998.

The greatest contrast between the surveys appears to be that Americans today spend most of their out of pocket total CAM expenditure on self-care products, classes and materials than on consulting practitioners, whereas 10 years ago it was the other way around:

“The present observation that about two-thirds of CAM costs were associated with self-care therapies contrasts with the findings of Eisenberg et al, who reported that the majority of CAM costs resulted from consultations with health-care professionals offering CAM services,” wrote the authors.

“Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007.”
Richard L. Nahin, Patricia M. Barnes, Barbara J. Stussman, and Barbara Bloom.
US Centers for Disease Control and Prevention.
National Health Statistic Report, Number 18, July 30, 2009 (PDF download).

Additional source: NIH/National Center for Complementary and Alternative Medicine.

Written by: Catharine Paddock, PhD