The health care industry has a variety of policies and
standards regarding coverages for alternative medicine
modalities. From a sociological standpoint, unconventional, alternative, or unorthodox therapies refer to medical practices that are not in conformity with the standards of the medical community. The New England Journal of Medicine defines
unconventional therapies, "as medical interventions not taught widely at U.S. medical schools or generally available at U.S. hospitals. Examples include acupuncture, chiropractic, and
massage therapy"(1993). Coverages vary widely among conventional carriers, preferred providers as well as the omnipresent Health Maintenance Organizations ("HMO"). The primary emphasis and, for that matter, the only reason for the existence of insurance companies is a single word, profit. More specifically, premiums less costs provide the all important profit margin, the life blood of the insurance industry. By not providing coverage for the billion dollar industry of alternative treatments, insurance companies are keeping the cost of the premiums down but at the same time not allowing their customers to use complementary treatments such as chiropractic to prevent or cure illness. The more rigid and restrictive the policy provisos, the more
assurance for the companies that they will maximize their bottom lines. Therefore, patients of alternative therapies as well as doctors must show that such unconventional treatment provides relief and prevention of illness. "The total projected out-of- pocket expenditure for unconventional therapy plus
supplements(such as diet pills and megavitamins)was 10.3 billion dollars in 1990. This is comparable to the out-of-pocket
expenditure for all hospital care in the United States in
1990($12.8 billion), and it is nearly half the amount spent out of pocket for all physicians' services in the United States($23.5 billion)"(nemj,1991). From this one may infer that society has become fed up with inadequate results or side effects associated with surgery and drugs which accompany the treatment of modern medicine. So, in an effort to cope with the inadequate treatment patients are receiving from conventional medicine, they are seeking alternatives such as chiropractic for chronic illness and pain. "Although most doctors wince when you mention
chiropractors, some fairly rigorous studies have shown their manipulations of the spine to be effective in relieving lower- back pain. Orthopedic surgeons have even been known to refer patients to chiropractors, and some 30 U.S. hospitals have
chiropractors on staff"(Wallis,1991).
Relevant Policies and/or Practices
"In 1997, 42 percent of all alternative therapies used were exclusively attributed to treatment of existing illness, whereas 58 percent were used to prevent future illness from occurring or to maintain health and vitality" (JAMA, 1998). "The magnitude of demand for alternative therapy is noteworthy, in light of the relatively low rates of insurance coverage for these services" (JAMA, 1998). Coverages vary widely depending on the policies provided by the carriers. In my research, I contacted the Kern County Superintendent of Schools, ("KCSOS"), Personnel Office to inquire into the health policies provided to the nearly one thousand employees of the office. There are a variety of options available to each employee. The basic hospitalization plan used by the majority of employees is the Blue Cross Prudent Buyer Hospital Only plan. As required by State and Federal law, the office is also required to make available approved HMO's if employees request them. To that end, the office has a large number of employees enrolled in Kaiser-Permanente and Health Net HMO's. The administrative agency that provides the programs is the Self Insured Schools of California, ("SISC"), which is a cost-containment consortium of hundreds of California...
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