Alternative therapies, including chiropractic, massage, herbal medicine, and acupuncture, are gaining popularity as covered benefits in employer health plans, a survey suggests.

The survey, "Health Benefits for Alternative Medicine," was authored by the International Foundation of Employee Benefit Plans (IFEBP), which polled 534 members of the foundation regarding their benefits for or discounts on alternative therapies.

The most frequently offered alternative care benefit is chiropractic care, covered by 86 percent of respondents. (Some states, however, mandate coverage of chiropractic care, which may skew the number.) Nineteen percent of respondents offer alternative benefits other than chiropractic, with 75 percent of those offering acupuncture, the next most popular covered alternative therapy. Massage therapy is the third most common.

Also offered by employers covering more than chiropractic care are, in descending order of popularity: nutrition counseling, naturopathy, herbal medicine, biofeedback, homeopathy, and yoga. A few employers also offer acupressure, fitness center discounts, Rolfing, and smoking-cessation programs.

Employee requests were cited as the No. 1 reason for introducing alternative care benefits. Among employers not offering alternative care benefits, "lack of sufficient proof of effectiveness" was the frequently cited reason. Other factors included "lack of cost data" and "legal/regulatory concerns."

Surprisingly, although employers commonly perform cost-benefit analyses of health plan coverage for traditional care, no employer responding to the survey knew whether offering alternative care benefits cut down on traditional-care spending. Prescription costs, primary care physician use, and other typical health plan expenditures have not been examined to determine whether they've decreased because of alternative care benefits.

Also according to the survey, employers use one of three strategies for offering alternative care: through a discounted network of care providers, where employees pay all costs, through on-site "wellness" programs, or through employer-sponsored health plans. Most employers offering alternative benefits — 86 percent — offered alternative care through health plans. Only a small number offered discounted network care (4 percent) or "wellness" programs (3 percent).

The survey comes on the heels of November 1998 Journal of the American Medical Association article estimating that 83 million people in the U.S. spend $33 billion each year on alternative therapies, suggesting that employer alternative care benfits are on-target for employee needs.