New Zealanders with low back pain seeking health care: a retrospective descriptive analysis of Accident Compensation Corporation-funded low back pain healthcare service usage
Julia Hill
1 * , Dylan Kay 2 , Jacob Gordon 2 , Imran Khan Niazi 3 4 5 , Nicola Saywell 6
1 Department of Physiotherapy, School of Clinical Sciences, Active Living and Rehabilitation: Aotearoa New Zealand, Auckland University of Technology, New Zealand.
2 Clinical Practice, Auckland, New Zealand.
3 Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
4 Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand.
5 Research Innovation Centre, Auckland University of Technology, New Zealand.
6 Department of Physiotherapy, School of Clinical Sciences, Research Innovation Centre, Auckland University of Technology, New Zealand.
Journal of Primary Health Care 15(3) 206-214 https://doi.org/10.1071/HC23010
Published: 29 May 2023
Abstract
Most New Zealanders experience low back pain (LBP) at least once throughout their lifetime and many seek help from the large range of health providers in primary care. Accident Compensation Corporation (ACC) funds a significant proportion of those claims, but which services are they funding and what are the costs?
This was a retrospective audit and descriptive analysis of ACC-funded, non-public hospital healthcare service use by people with LBP in New Zealand (NZ). Outcome measures were the healthcare services accessed by people with ACC-funded LBP,the claims (all occurrences for a service that has generated a payment/year), single contact (with a service), and costs (NZ$) for services between 2009 and 2020.
The number of claims for services were 129 000 for physiotherapy, 105 000 for general practitioner and 59 000 for radiology services. Per single contact, elective surgery and radiology services were the most expensive. During 2009–2020, there were 3.3 million ACC claims for LBP with a total cost of NZ$4 billion. Over this time, there was an increase in claims, costs and single contacts. Costs decreased slightly during 2010 due to changes in healthcare funding and in 2020 due to the COVID-19 pandemic.
Consumers have considerable choice in where they access health care for ACC-funded LBP services. This study shows the services they use most frequently and the cost to NZ for those services. These data can inform service planning for ACC-funded LBP health care in NZ.
Keywords: ACC, claims, costs, disability, general practitioner, healthcare services, low back pain, physiotherapy.
References
1 Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet 2018; 391(10137): 2356-2367.
| Crossref | Google Scholar |
2 Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396(10258): 1204-1222.
| Crossref | Google Scholar |
3 Darlow B, Perry M, Stanley J, et al. Cross-sectional survey of attitudes and beliefs about back pain in New Zealand. BMJ Open 2014; 4(5): e004725.
| Crossref | Google Scholar |
4 Pengel LHM. Acute low back pain: systematic review of its prognosis. BMJ 2003; 327(7410): 323.
| Crossref | Google Scholar |
5 da Silva T, Mills K, Brown BT, et al. Recurrence of low back pain is common: a prospective inception cohort study. J Physiother 2019; 65(3): 159-165.
| Crossref | Google Scholar |
6 Stevans JM, Delitto A, Khoja SS, et al. Risk factors associated with transition from acute to chronic low back pain in US patients seeking primary care. JAMA Netw Open 2021; 4(2): e2037371.
| Crossref | Google Scholar |
7 National Health Committee. Low back pain: A pathway to prioritisation. 2015. Available at https://www.health.govt.nz/system/files/documents/publications/nhc-lbp-pathway-to-prioritisation.pdf
8 Becker A, Held H, Redaelli M, et al. Low back pain in primary care: costs of care and prediction of future health care utilization. Spine 2010; 35(18): 1714-1720.
| Crossref | Google Scholar |
9 Jo C. Cost-of-illness studies: concepts, scopes, and methods. Clin Mol Hepatol 2014; 20(4): 327-337.
| Crossref | Google Scholar |
10 ACC. Low back pain data. 2023. Available at https://catalogue.data.govt.nz/dataset/low-back-pain-data/resource/f8fdddf8-2d35-4690-b969-f1e3a0020fd2 [accessed 24 April 2023].
11 Accident Compensation Corporation. Treatment we can help pay for. 2023. Available at https://www.acc.co.nz/im-injured/what-we-cover/treatment-we-pay-for/
12 Baxter GD, Chapple C, Ellis R, et al. Six things you need to know about low back pain. J Prim Health Care 2020; 12(3): 195-198.
| Crossref | Google Scholar |
13 Physiotherapy Board of New Zealand. Physiotherapy standards framework. 2018. Available at https://www.physioboard.org.nz/wp-content/uploads/2018/03/Physiotherapy-Board-Code-Standards-Thresholds.pdf
14 Moffatt F, Goodwin R, Hendrick P. Physiotherapy as first point of contact service for patients with musculoskeletal complaints: understanding the challenges of implementation. Prim Health Care Res Dev 2018; 19(2): 121-130.
| Crossref | Google Scholar |
15 Beyera GK, O’Brien J, Campbell S. Health-care utilisation for low back pain: a systematic review and meta-analysis of population-based observational studies. Rheumatol Int 2019; 39(10): 1663-1679.
| Crossref | Google Scholar |
16 Buchbinder R, Underwood M, Hartvigsen J, et al. The Lancet Series call to action to reduce low value care for low back pain: an update. Pain 2020; 161(Suppl 1): S57-S64.
| Crossref | Google Scholar |
18 Wilson R, Pryymachenko Y, Abbott JH, et al. A guideline-implementation intervention to improve the management of low back pain in primary care: a difference-in-difference-in-differences analysis. Appl Health Econ Health Policy 2023; 21(2): 253-262.
| Crossref | Google Scholar |
19 Feuerstein M, Marcus SC, Huang GD. National trends in nonoperative care for nonspecific back pain. Spine J 2004; 4(1): 56-63.
| Crossref | Google Scholar |
20 Hashemi L, Webster BS, Clancy EA. Trends in disability duration and cost of workers’ compensation low back pain claims (1988-1996). J Occup Environ Med 1998; 40: 1110-1119.
| Crossref | Google Scholar |
21 Mafi JN, McCarthy EP, Davis RB, et al. Worsening trends in the management and treatment of back pain. JAMA Intern Med 2013; 173(17): 1573-1581.
| Crossref | Google Scholar |
22 Mattila VM, Sillanpää P, Visuri T, et al. Incidence and trends of low back pain hospitalisation during military service – An analysis of 387,070 Finnish young males. BMC Musculoskelet Disord 2009; 10(1): 10.
| Crossref | Google Scholar |
23 Accident Compensation Corporation. Lodging a claim for a patient. 2023. Available at https://www.acc.co.nz/for-providers/lodging-claims/lodging-a-claim-for-a-patient/
24 Accident Compensation Corporation. Privacy Impact Assessment: Statistical models used to improve the claim registration and approval process. Vol. 1. 2018. pp. 1–25. (ACC) Available at https://www.acc.co.nz/assets/im-injured/2a239c130c/claims-approval-privacy-impact-assessment.pdf
25 Ministry of Justice. Official Information Act 1982. 1982. Available at https://www.legislation.govt.nz/act/public/1982/0156/latest/DLM64785.html
26 Kamper SJ, Logan G, Copsey B, et al. What is usual care for low back pain? A systematic review of health care provided to patients with low back pain in family practice and emergency departments. Pain 2020; 161(4): 694-702.
| Crossref | Google Scholar |
27 Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J 2018; 27(11): 2791-2803.
| Crossref | Google Scholar |
28 Accident Compensation Corporation. Pain management service: guidelines for providers. 2020. Available at https://www.acc.co.nz/assets/contracts/pain-management-og.pdf
29 Accident Compensation Corporation. Getting back to work after an injury. 2023. Available at https://www.acc.co.nz/im-injured/financial-support/return-to-work/
30 Goodwin RW, Hendrick PA. Physiotherapy as a first point of contact in general practice: a solution to a growing problem? Prim Health Care Res Dev 2016; 17(5): 489-502.
| Crossref | Google Scholar |
31 Cornwall J, Melloh M. Do New Zealand nurses claim more lumbar spine injuries than the general population? A retrospective study (1995–2009). N Z Med J 2012; 125(1348): 112-115.
| Google Scholar |
32 Grimmer-Somers K, Prior M, Robertson J. Yellow flag scores in a compensable New Zealand cohort suffering acute low back pain. J Pain Res 2008; 1: 15-25.
| Crossref | Google Scholar |
33 King D, Hume PA, Hardaker N, et al. Sports-related injuries in New Zealand: National Insurance (Accident Compensation Corporation) claims for five sporting codes from 2012 to 2016. Br J Sports Med 2019; 53(16): 1026-1033.
| Crossref | Google Scholar |
34 McBride D, Begg D, Herbison P, et al. Low back pain in young New Zealanders. N Z Med J 2004; 117(1203): U1099.
| Google Scholar |
35 Dionne CE, Dunn KM, Croft PR, et al. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine 2008; 33: 95-103.
| Crossref | Google Scholar |
36 Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet 2018; 391(10137): 2368-2383.
| Crossref | Google Scholar |
37 Jenkins HJ, Downie AS, Maher CG, et al. Imaging for low back pain: is clinical use consistent with guidelines? A systematic review and meta-analysis. Spine J 2018; 18(12): 2266-2277.
| Crossref | Google Scholar |
38 Downie A, Hancock M, Jenkins H, et al. How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years. Br J Sports Med 2020; 54(11): 642-651.
| Crossref | Google Scholar |
39 Ivanova JI, Birnbaum HG, Schiller M, et al. Real-world practice patterns, health-care utilization, and costs in patients with low back pain: The long road to guideline-concordant care. Spine J 2011; 11(7): 622-632.
| Crossref | Google Scholar |
40 Lemmers GPG, van Lankveld W, Westert GP, et al. Imaging versus no imaging for low back pain: a systematic review, measuring costs, healthcare utilization and absence from work. Eur Spine J 2019; 28(5): 937-950.
| Crossref | Google Scholar |
41 Kim LH, Vail D, Azad TD, et al. Expenditures and health care utilization among adults with newly diagnosed low back and lower extremity pain. JAMA Netw Open 2019; 2(5): e193676.
| Crossref | Google Scholar |
42 Weeks WB, Pike J, Donath J, et al. Conservative spine care pathway implementation is associated with reduced health care expenditures in a controlled, before-after observational study. J Gen Intern Med 2019; 34(8): 1381-1382.
| Crossref | Google Scholar |
43 Spears CA, Hodges SE, Kiyani M, et al. Health care resource utilization and management of chronic, refractory low back pain in the United States. Spine 2020; 45(20): E1333-E1341.
| Crossref | Google Scholar |
44 Accident Compensation Corporation. Annual Report 2010. 2010. Available at https://www.parliament.nz/resource/mi-NZ/49DBHOH_PAP20617_1/d9dfd1815091dc696870637725bd2aadefe9a269
45 Smith N. Government announces 2010/11 ACC levy rates. 2009. Available at https://www.beehive.govt.nz/release/government-announces-201011-acc-levy-rates
46 Accident Compensation Amendment Act. 2010. (New Zealand Government, Parliamentary Counsel Office) Available at https://www.legislation.govt.nz/act/public/2010/0001/latest/DLM2417504.html
47 Accident Compensation Corporation. Annual Report 2011. 2011. Available at https://www.parliament.nz/resource/en-NZ/49DBHOH_PAP22223_1/204e5e3941bbed62ab94ba35be9d404d1312dd02
48 Accident Compensation Corporation. Annual Report 2020. 2020. Available at https://www.acc.co.nz/assets/corporate-documents/annual-report-2020-acc8234.pdf
49 Baker MG, Wilson N, Anglemyer A. Successful elimination of COVID-19 transmission in New Zealand. N Engl J Med 2020; 383(8): e56.
| Crossref | Google Scholar |
50 Haldeman S, Nordin M, Tavares P, et al. Distance management of spinal disorders during the COVID-19 pandemic and beyond: evidence-based patient and clinician guides from the global spine care initiative. JMIR Public Health Surveill 2021; 7(2): e25484.
| Crossref | Google Scholar |
51 Imlach F, McKinlay E, Middleton L, et al. Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences. BMC Fam Pract 2020; 21(1): 269.
| Crossref | Google Scholar |
52 Ohm E, Hauge LJ, Madsen C, et al. Impact of the COVID-19 pandemic on the treatment of injuries during lockdown in Norway. Scand J Public Health 2021; 49: 689-696.
| Crossref | Google Scholar |
53 Schäfer I, Hansen H, Menzel A, et al. The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: results of a longitudinal observational study. BMC Fam Pract 2021; 22(1): 125.
| Crossref | Google Scholar |
54 Licciardone JC. Demographic characteristics associated with utilization of noninvasive treatments for chronic low back pain and related clinical outcomes during the COVID-19 pandemic in the United States. J Am Board Fam Med 2021; 34: S77-S84.
| Crossref | Google Scholar |
55 Accident Compensation Corporation. First quarterly report 2020/21. 2021. Available at https://www.acc.co.nz/assets/corporate-documents/first-quarterly-report-2020-2021.pdf
56 GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. . Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392(10159): 1789-1858.
| Crossref | Google Scholar |
