Insurance Costs for Massage: Response to The Toronto Star

In the article The Rise of the Three Amigos of Health Care, Adam Mayers presents valid concerns for how employer-sponsored benefit plans are utilized.  He describes specifically physiotherapy, chiropractic and massage therapy providing “soft benefits” ie: harder to measure – and the associated costs that could affect money spent on pharmaceuticals.  I’m writing to add additional context to the concerns Mr. Mayer raises.

There is a surprising lack of financial support for treatment of the structural components of the body that help us to move – muscles and connective tissues.  Chiropractic and physiotherapy were removed from the provincial health plan in 2004 – presumably to shunt dollars to treatments for heart disease, cancer, diabetes and other chronic illnesses with some association to lifestyle choices.  Massage therapy – despite being regulated as a health profession in Ontario since 1919 – has curiously never been covered under OHIP.

Provincial funding for orthopedic treatment of osteoarthritis or severely traumatized joints is not extended to strains and sprains affecting the everyday function of people.  It appears these injuries and ailments hold low priority, and employers – rather than our health care system – are mandated to pay for them.  Case in point – a person experiencing soft-tissue and joint injuries in a motor vehicle collision must tax their employer-paid benefits first before applying for claimant-paid auto-insurance benefits.  I’m not sure why employers aren’t up in arms over this and organizing a response to the insurance industry.

I wonder if Greenshield in their data review has considered that rising expenditures in these areas are a shift from drugs to physical/psychological therapies as a reflection of the population preferring less invasive or dangerous interventions to pharmaceuticals or surgery.  Judicious treatment of soft-tissue injuries may preclude or limit the need for more invasive interventions, or obviate the serious side-effects associated with the ingestion of pharmaceuticals such as Non-Steroidal Anti-Inflammatory drugs (NSAIDs).

True, there is a lack of accountability on how employee benefit plans are used.  Employers trust employees to search out practitioners in the open marketplace that can help them address various symptoms affecting health and wellness.  There is currently no measure in place to assure the employer that the benefits have been well directed or effective.

Practitioners – the vast majority ethical, compassionate and competent – are penalized for excessive or unnecessary billing only if there is an investigation by their regulatory body or a criminal conviction.  No question, a few unscrupulous providers are casting a dark pall over the reputations of the majority of these regulated professionals.  As well, more accountability for how these benefits are used is long overdue.

Perhaps designing a system similar to a trust fund – where employees and employers pay in – and health professions provide approved treatment plans substantiated by the best evidence available – may improve the situation.  The current system that pools risk to lower costs creates incentive for employees to use plans without judicious consideration (or accountability to the employer) of where and how the money is spent, and incentive for insurance companies to deny claims or discredit credible services to improve profit margins.  Turn “soft benefits” into hard by establishing clear workplace outcomes – reduced time off work, increased job satisfaction and sense of well-being – and ensure workplace benefits are used toward those outcomes.  Practitioners could be registered and would lose access if outcomes were not reached.

Its unfortunate Greenshield refers to these 3 regulated health professions in a derogatory manor.  Of particular concern is Greenshield’s vice president David Willows referring to massage therapy as “a special treat”.  As mentioned, massage therapy has been regulated in Ontario since 1919 as a health profession, and demonstrates effectiveness in the treatment of headaches, lower back pain, arthritis-related stiffness and pain, muscle discomforts related to pregnancy, and most recently efficacy in the treatment of anxiety.  It appears Mr. Willows is unaware of the evidence favouring massage therapy to address a number of health concerns.  Ironically, employees in the insurance industry – along with the technology and finance industries – are cited as some of the greatest users of employee benefit plans.

It would be helpful if Greenshield and the insurance industry worked in collaboration with research and educational institutions to draft a cost-benefits analysis how physiotherapy, chiropractic and massage therapy may off-set costs that would typically show up in the provincially-funded medical system.  The insurance industry may complain of the rising use in employee benefit plans, and employers are justifiably concerned about shouldering these costs, but is this a red herring?

Without study, we won’t know if in fact expenditures for these “3 Amigos” may actually be saving the provincial health care plan a considerable expense.  Job-related stress, for example is estimated to cost the Canadian economy $16 Billion dollars/year.  As per Mr. Willows claim about the drugs that can “send you from bed back to work”, please elaborate…I’m unaware of such miracle drugs and would be quite interested in their efficacy.

As for the mention of children receiving care, it appears we are seeing children at younger ages developing the same afflictions their parents and grand-parents suffer from.  Perhaps the focus should be on correcting the social-economic mechanisms that affect quality of life and trigger repeated responses to stress rather than precluding populations simply because they appear novel in our consideration of health and quality of life.

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