Report Highlights
An Internal Review commissioned
by the Ministry of Health November 1994
Executive Summary
1. The Chiropractic Services Review (CRS) Committee has been a bipartite Committee with representatives from the Ministry of Health ("Ministry") and Ontario Chiropractic Association ("OCA"). Its Terms of Reference (Appendix A) call for recommendations on many aspects of the delivery and funding of chiropractic services in Ontario. More detailed background on the review and chiropractic services appears in the Introduction to this report.
2. This has been the fullest review of chiropractic services ever conducted by the Ministry and the OCA. There has been wider consultation, and more detailed exchange of information, than ever before.
3. The CSR Committee was successful in achieving agreement on all its recommendations, which are summarized below. With respect to these recommendations:
a) Most are aimed at achieving better integration of chiropractic services with Ontario’s health care system, and removing or minimizing inappropriate barriers to access. Since chiropractic services were first covered by the Ontario Health Insurance Plan in 1970 the chiropractic profession has grown considerably in numbers, stature and acceptance by the public and the scientific community. This, and other changes in the health care system, mean that a number of reforms as set forth in the recommendations are now necessary.
b) The first two recommendations appear in Chapter 1 which reviews the Manga Report, funded by the Ministry of Health, conducted by Professor Pran Manga and colleagues at the University of Ottawa, and titled The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain.
c) The other recommendations are supported by chapters with this common format:
i. Identification and statement of an issue or issues.
ii. Recommendations in response.
iii. Discussion, including specific discussion of any legal changes required by the recommendations and their funding implications.
Chiropractic Services Review Recommendations
The Committee recommends:
Chapter 1: The Manga Report
R1.1 That on the grounds of effectiveness, safety, patient satisfaction and public acceptance of chiropractic services, particularly in the management of neuro-musculoskeletal disorders, chiropractic services should continue to be accepted and funded by the Ontario Health Insurance Plan.
R1.2 That the citizens of Ontario should have improved and genuine freedom of choice of chiropractic services. To achieve this a number of barriers to access should be removed.
Chapter 2: Health Human Resources Planning and Education
R2.1 That chiropractic education be placed in the multidisciplinary atmosphere of a university, and be funded in a manner similar to other health professions.
R2.2 That the government develop a health human resources (HHR) plan with respect to chiropractic services.
Chapter 3: Chiropractic Radiology Services
R3.1 That chiropractors be permitted to refer patients to independent health facilities (IHFs) for diagnostic radiology services on the basis that the IHF provides the technical component and the chiropractor provides the professional component.
R3.2 That chiropractors be permitted to refer patients for out-patient diagnostic radiology services in public hospitals on the basis that the hospital provides the technical component and the chiropractor provide the professional component, and that Regulation 965 of the Public Hospitals Act (PHA) be amended accordingly.
Chapter 4: Specialist Referrals
R4.1 That medical specialists be allowed to bill OHIP for a referred consultation with respect to patients referred directly by a chiropractor.
Chapter 5: Diagnostic Code Revisions
R5.1 That the current list of chiropractic diagnostic codes and corresponding physician codes be changed to a more specific, appropriate list of codes that is used on a uniform basis by different providers.
Chapter 6: Laboratory Diagnosis
R6.1 That chiropractors should be able to order a limited range of laboratory tests as specified by the College of Chiropractors of Ontario, and that the performance of these tests should be an insured service under OHIP.
Chapter 7: Access and Funding
R7.1 That opportunities should be available for salaried positions for chiropractors in hospitals and long-term care facilities.
R7.2 That the Ministry of Health should promote and encourage the use of chiropractic services, through salaried positions and other non fee-for-service mechanisms, in health service organizations, community health centres and comprehensive health organizations. Steps taken should include making these organizations aware of the potential role and value of chiropractic services.
R7.3 That the current level of co-payments for chiropractic services, particularly in a multi-disciplinary health care system where other services have no co-payment, represents an inequitable barrier to access which should be minimized.
R7.4 That the definition of the chiropractic insured services in Regulation 552 under the Health Insurance Act be revised to limit the insured service to that part for which payment is made by the Ministry, thereby allowing private insurance coverage of the co-payment.
R7.5 That chiropractic services insured under the mandatory automobile insurance policy benefits set forth in the Statutory Accidents Benefits Schedule under the Insurance Act should not be insured services under OHIP.
Chapter 8: Research and Clinical Guidelines
R8.1 That the government should undertake public and provider surveys with respect to the incidence and management of low-back pain.
R8.2 That a formal multidisciplinary consensus process for the development of practice guidelines for the management of mechanical low-back pain should be initiated.
R8.3 That a set amount of money per annum be allocated for three years for the guidelines process and clinical outcomes research in areas of chiropractic, medical and other management of low-back pain, neck pain and headache.
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