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Consultation regarding the request to increase the scope of practice by Alberta's chiropractors


Release Date: 06/02/2016
Staff Reference: Joan Weir

June 2, 2016

Shawn Knight
Executive Director, Health Human Resource Planning & Strategy Branch
Professional Services & Health Benefits Division
Alberta Health
10 floor, ATB Place North Tower
10025 Jasper Avenue
Edmonton, Alberta
T5J 2N3


Re: Policy Consultation for registered Chiropractors on the profession's request for an increase to their scope of practice.

On behalf of the Canadian life and health insurance industry, we appreciate the opportunity to provide you with our comments on the proposed changes to the professional regulations of the Alberta College and Association of Chiropractors (ACAC).

The CLHIA is a voluntary trade association with member companies that account for 99 percent of Canada's life and health insurance business. In Alberta, at the end of 2014, the life and health insurance industry provided some 2.8 million Alberta residents with supplementary health benefit coverage and made payments of about $3 billion under these plans. During 2014, of this total, the industry also reimbursed roughly $334 million for paramedical and other healthcare goods and services - which includes the reimbursement of services provided by registered chiropractors.

It is our understanding from the materials provided that the ACAC has applied to allow appropriately trained chiropractors to deliver electrodiagnosis (EDx) in needle electromyography and nerve conduction studies, as well as to apply non-ionizing radiation in ultrasound imaging. The benefit to Albertans is stated to be increased and faster access to these services that are today delivered by medical specialists and radiologists.

While CLHIA will not comment on the medical questions that surround this decision, we would note that, if granted, this would be the first jurisdiction in Canada to allow chiropractors who have taken the training to deliver EDx and apply non-ionizing radiation. In the US, this scope change has been taking place over the past decade and it might be worthwhile to consider their experience.

The services of Chiropractors are frequently included as part of an employee's overall benefits plan. The services covered may range from traditional chiropractic adjustments to other types of therapies, such as laser treatments. Typically, benefit plans would not reimburse all services included within a chiropractor’s scope of practice. The materials submitted to you from the ACAC indicate that, in reference to private insurance, “Generally, this coverage is provided for any diagnostic or treatment modality that chiropractors are authorized to provide.” We would caution that this may be the case and Albertans would be required to pay for this service, now covered under the public plan.

On a final point, plan sponsors, typically employers, in Alberta are struggling to sustain their existing levels of coverage for their employees. Even though most benefit plans offer a limited or capped maximum towards the payment of eligible chiropractor services, plan sponsors have seen growth in the 'paramedical' portion of the benefit plan, which includes chiropractor services, of 17% between 2013 and 2014, from $1.7 B to $2.0 B dollars. This trend has continued in 2015 and to date in 2016. Given this overall context, we would caution against any assumption that employers, on mass, will choose to pick up the associated costs with this expanded scope.

We thank you for the opportunity to provide input from the insurance industry. We would be pleased to discuss this with you at your convenience or provide any other information that you would find helpful.

Sincerely,
Original Signed by Joan Weir
Joan Weir
Director, Health and Dental Policy
jweir@clhia.ca / 416-359-2003