Americans spent $30.2 billion—$28.3 billion for adults and $1.9 billion for children—out-of-pocket on complementary health approaches, according to a nationwide survey.

These approaches include a group of diverse medical and healthcare systems, practices, and products such as herbal supplements, meditation, chiropractic and yoga. This amount represents 9.2% of all out-of-pocket spending by Americans on healthcare and 1.1% of total healthcare spending.

These findings come from an analysis by the National Center for Complementary and Integrative Health (NCCIH) and the Centers for Disease Control and Prevention, based on data from a special supplement—on use of complementary health approaches—to the 2012 National Health Interview Survey (NHIS). The NHIS is a large survey conducted annually by CDC’s National Center for Health Statistics. NCCIH is part of the National Institutes of Health.

“With so many Americans using and spending money on complementary health approaches, it is extremely important for us to provide the public with evidence-based information to help inform decisions,” said Josephine Briggs, MD, director of NCCIH. “This underscores the importance of conducting rigorous research to know whether the products and practices being used are safe and effective.”

How much did Americans spend on different types of complementary approaches? The survey showed:

• Americans spent $14.7 billion out-of-pocket on visits to complementary practitioners such as chiropractors, acupuncturists or massage therapists. That is almost 30% of what they spent out-of-pocket on services by conventional physicians. They spent more on visits to complementary practitioners than on natural product supplements or self-care purchases, and the mean annual out-of-pocket expenditure for practitioner visits was $433.
• Americans spent $12.8 billion out-of-pocket on natural product supplements, which was about one-quarter of what they spent out-of-pocket on prescription drugs. The mean annual out-of-pocket expenditure in this category was about $368.
• Total spending on purchases related to self-care approaches (for example self-help materials, such as books or CDs, related to complementary health topics) was $2.7 billion, and the mean annual out-of-pocket expenditure per user was $257.

As family income went up, out-of-pocket spending on complementary approaches went up significantly. The average per user out-of-pocket expenditure for complementary health approaches was $435 for people with family incomes of less than $25,000, and $590 for those with family incomes of $100,000 or more. Out-of-pocket expenditures for visits to complementary practitioners averaged $314 for people with family incomes of less than $25,000 and $518 for those with family incomes of $100,000 or more.

“We did an earlier study on cost data from the 2007 NHIS, which was not directly comparable to this one because of differences in survey design,” said Richard Nahin, PhD, NCCIH’s lead epidemiologist and lead author of the expenditures on complementary health approaches analysis. “However, globally, in both years, substantial numbers of Americans spent billions of dollars out-of-pocket on these approaches, an indication that users believe enough in the value of these approaches to pay for them.”

Read more about this report and other data on the use of complementary health approaches: https://nccih.nih.gov/research/statistics/NHIS/2012.