There is no doubt that the Affordable Care Act is driving health care in new directions; the integration of behavioral health into primary care; the move from acute to ambulatory care; primary care for seniors in the home delivered by nurse practitioners; an emphasis on nutrition, exercise, and other forms of wellness interventions to maintain and improve health; and a focus on the value of care through the documentation of outcomes. It will be interesting to monitor expenditures on care over the next several decades as the system adjusts. For example, in 2007, $2.2 trillion was spent in the United States on traditional health care including procedures, devices, drugs, and doctors' visits.1 Of this staggering amount, $2.86 billion was out-of-pocket expenditure-surgical procedures and drugs not covered by insurance, concierge medical practices, and other treatments prescribed by conventional providers but not covered.
In the same year, US citizens spent $33.9 billion, out of pocket, on CAM (complementary and alternative medicine) therapies: $22 million on self-care products such as nonvitamin and nonmineral natural products and a variety of holistic practitioners. These expenditures constitute 11.2% of total out-of-pocket health care expenditures, conventional and CAM. The remaining $11.9 billion was spent on visits to CAM practitioners such as massage therapists, chiropractors, acupuncturists, holistic nutritionists, yoga masters, and those who teach meditative techniques. To illustrate the power of Eastern self-care modalities, $4.1 billion was spent on yoga, tai chi, and qigong.
One interesting statistic in these accountings is the fact that whether for conventional or CAM interventions, 11% of dollars spent for health care are out of pocket, an indicator of the growing willingness to invest in, to take charge of, and to make discrete choices with respect to health and self-care. But are the results worth the expenditure?
The Cochrane Collaboration is the premier site for reporting evidence on both conventional and CAM interventions. A visit to the Cochrane site (http://www.cochrane.org) enables you to search the database for evidence-based reviews of CAM interventions. My last search of the term "Complementary and Alternative Medicine Interventions" on the Cochrane site yielded 685 reports, and this search could be narrowed down to specific interventions. There is, however, a problem. Many of the research studies have small samples and the effects cannot be generalized to a population. More importantly, what can be generalized to a population cannot be guaranteed to work in everyone because of individual differences. The good news is that CAM interventions are increasingly the subject of research and the results are encouraging. In this era of "big data," it may someday be possible to access health information of those US citizens who spent $33.9 billion of their money on CAM products and interventions. It is my guess that there will be some "bang for the buck," but how much is still the question.
-Gloria F. Donnelly, PhD, RN, FAAN
Editor in Chief
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