National Health Statistics Reports
 

Number 95  June 22, 2016 

Expenditures on Complementary Health Approaches:
 

United States, 2012 


by Richard L. Nahin, Ph.D., M.P.H., National Institutes of Health; Patricia M. Barnes, M.A., National Center for Health 

Statistics; and Barbara J. Stussman, B.A., National Institutes of Health 

Abstract 

Objective—This report presents estimates of expenditures on complementary 

health approach use among the U.S. population. Estimates are presented for adults and 

children separately and combined, as well as stratified by type of approach and family 

income. 

Methods—Combined data from 44,743 individuals aged 4 years and over, 

collected as part of the 2012 National Health Interview Survey, were analyzed 

for this report. Sample data were weighted to produce national estimates that are 

representative of the civilian noninstitutionalized U.S. population. Differences 

between percentages were evaluated using two-sided significance tests at the 0.05 

level. Linear regression was used to assess trends in expenditures when stratifying by 

family income. 

Results—An estimated 59 million persons aged 4 years and over had at least one 

expenditure for some type of complementary health approach, resulting in total outof-pocket expenditures of $30.2 billion. More was spent on visits to complementary 

practitioners ($14.7 billion) than for purchases of natural product supplements 

($12.8 billion) or self-care approaches ($2.7 billion). The mean per user out-of-pocket 

expenditure for visits to a complementary practitioner ($433) was significantly more 

than for purchases of natural product supplements ($368) or for self-care approaches 

($257). Adults had higher mean annual out-of-pocket expenditures for visits to 

complementary practitioners than children ($442 and $291, respectively). Total out-ofpocket expenditures and mean per user out-of pocket expenditures for complementary 

health approaches increased significantly as family income increased. The mean per 

user out-of-pocket expenditure for complementary health approaches was $435 for 

persons with family incomes less than $25,000 and $590 for persons with family 

incomes of $100,000 or more. 

Keywords: complementary and alternative medicine • out-of-pocket expenditures 

• National Health Interview Survey 

Introduction 

Complementary health approaches 

comprise a diverse set of healing 

philosophies, therapies, and products 

(1,2). The continuing high use of 

complementary health approaches by 

adults (38.3%) (1) and children (11.8%) (2) 

in the United States has led to increased 

interest in identifying the costs associated 

with these approaches (3–12). Previous 

studies have estimated that U.S. adults 

spend between $27 and $34 billion in 

out-of-pocket expenditures per year on 

complementary health approaches (5,6,10). 

No prior analyses have: (a) provided 

nationally representative estimates on the 

out-of-pocket expenditures for children; 

(b) examined total expenditures across 

age groups; or (c) calculated mean out-ofpocket expenditures per user. In response 

to this lack of cost data, the Institute of 

Medicine (13) noted that new surveys 

were necessary to “provide much needed 

information about out-of-pocket costs... 

for individual therapies.” 

This report is based on supplements 

on complementary health approaches 

administered as part of the Sample Adult 

and Sample Child questionnaires of the 

2012 National Health Interview Survey 

(NHIS). Previous reports have described 

the prevalence of complementary 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
 

Centers for Disease Control and Prevention
 

National Center for Health Statistics
 
 

 

Page 2 National Health Statistics Reports  Number 95  June 22, 2016 

health approach use by adults (1) and 

children (2). This report focuses on 

the out-of-pocket expenditures on 

complementary health approaches. 

Estimates of annual total out-of-pocket 

expenditures and per user out-of-pocket 

expenditures for complementary health 

approaches are presented, as well as 

data on the frequency of expenditures 

for these approaches by the U.S. 

public. This report also examines the 

relationship between family income and 

expenditures. 

Methods 

Data source 

The statistics shown in this report 

are based on data from the 2012 NHIS 

Adult and Child Complementary and 

Alternative Medicine Supplement. 

The processes used to develop this 

supplement are described elsewhere (14). 

NHIS is conducted continuously by the 

National Center for Health Statistics. 

It is a multipurpose health survey of a 

nationally representative sample of the 

civilian noninstitutionalized household 

population of the United States. In the 

survey’s Family component, basic health 

and demographic information is collected 

on all household members. Information 

is collected on one randomly selected 

adult aged 18 and over (the “sample 

adult”) and on one randomly selected 

child aged 0–17 years (the “sample 

child”) in each family. Information on 

the sample adult is self-reported, except 

in rare cases when the sample adult 

is physically or mentally incapable of 

responding. Information on the sample 

child is collected from an adult who 

is knowledgeable about the child’s 

health, usually a parent. Interviews are 

conducted in the respondent’s home using 

a computer-assisted personal interview 

questionnaire, with telephone followup permitted if necessary. Detailed 

descriptions of the NHIS sample design 

and survey questionnaires for specific 

years are available elsewhere (15,16). 

In 2012, information was collected on a 

total of 34,525 adults aged 18 and over 

(unconditional response rate of 61.2%) 

and 13,275 children under 18 years 

(unconditional response rate of 69.7%). 

The 2012 Child Complementary and 

Alternative Medicine Supplement only 

included sample children aged 4–17 years 

(n = 10,218). 

The complementary health 

approaches analyzed for this report 

include: acupuncture, Ayurveda, 

biofeedback, chelation therapy, 

chiropractic and osteopathic 

manipulation, energy healing therapy, 

diet-based therapies, guided imagery, 

homeopathic treatment, hypnosis, 

massage therapy, meditation, naturopathy, 

natural product supplements, progressive 

relaxation, qi gong, tai chi, yoga, 

movement therapies, craniosacral 

therapy, and traditional healers. 

Calculation of estimates 

All estimates and associated standard 

errors shown in this report (Tables 1–5) 

were generated using SUDAAN, a 

software package designed to account 

for a complex sample design such as 

NHIS (17). All estimates for adults 

were calculated using the sample adult 

sampling weights, and all estimates for 

children were calculated using the sample 

child sampling weights to represent 

the U.S. civilian noninstitutionalized 

population aged 4 years and over. 

The steps for calculating out-of-pocket 

expenditures from the 2012 NHIS 

Adult and Child Complementary and 

Alternative Medicine Supplement are 

described elsewhere (10,11). In brief, 

for this analysis, the number of visits to 

a complementary alternative medicine 

practitioner was calculated using the 

midpoint of the interval containing the 

number of visits. These intervals were 

2–5, 6–10, 11–15, and 16–20 times. For 

response categories “only one time” 

and “more than 20 times,” the values 

1 and 21 were used, respectively. To 

estimate the out-of-pocket costs per 

visit and the costs for the purchase of 

homeopathic medicine; yoga, tai chi, 

and qi gong classes; and relaxation 

technique materials, the continuous 

responses of “$0–$499” were retained 

and the response of “$500 or more” 

was treated as $500. To estimate how 

often natural product supplements and 

homeopathic medicines were purchased, 

the respondent’s original answer of times 

per day, week, or month was converted 

into times per year. The number of 

times a person took a yoga, tai chi, or qi 

gong class was calculated by using the 

midpoint of the interval containing the 

number of times the person took a class. 

These intervals were 2–11 times per year, 

2–3 times per month, 2–3 times per week, 

and 4–6 times per week. Responses of 

daily, times per week, and times per 

month were then converted into times 

per year. Based on prior cognitive testing 

results of the 2012 NHIS Complementary 

and Alternative Medicine Supplement, 

few respondents reported buying natural 

product supplements as often as daily. 

Responses indicating purchases of natural 

product supplements of more than 365 

times per year were therefore excluded 

from the analysis as presumed errors. 

The question and response categories for 

these recodes can be found in the 2012 

NHIS Sample Adult and Sample Child 

Complementary and Alternative Medicine 

questionnaire located on the NHIS 

website at: http://www.cdc.gov/nchs/ 

nhis/quest_data_related_1997_forward. 

htm. Persons with unknown information 

about complementary health approaches 

were excluded from the analysis. Also 

excluded were 15 individuals identified 

as having extreme values (top 0.1%) 

using SAS Proc Univariate. 

The family income variable shown in 

Tables 4 and 5 is based on detailed family 

income for which item nonresponse is 

relatively high, as is common in large 

population surveys. To reduce biases 

associated with missing data, information 

on family income and personal earnings 

is imputed by NCHS analysts using 

multiple imputation methodology. 

Five ASCII data sets containing 

imputed values for the 2012 NHIS and 

additional documentation about the 

imputed income variables and files can 

be found at: http://www.cdc.gov/nchs/ 

nhis/2012imputedincome.htm. 

The Taylor series linearization 

method was chosen for estimation of 

standard errors. Prevalence estimates 

were compared using two-tailed z tests. 

Analysis of Variance (ANOVA) was 

used to assess overall differences in 

expenditures for complementary health 

approaches between adults and children. 

When a significant overall difference 

was observed, the Tukey post-hoc test 

was used to compare differences between 
National Health Statistics Reports  Number 95  June 22, 2016	 Page 3 

adults and children for three categories 

of complementary health approaches: 

visits to complementary practitioners, 

purchases of natural product 

supplements, and self-care approaches. 

Linear regression was used to assess 

whether increasing family income was 

associated with increasing expenditures 

on complementary health approaches. 

Significance for all statistical tests was 

set at 0.05 and assumed independence. 

Terms such as “greater than” and 

“less than” indicate a statistically 

significant difference. Terms such as “not 

significantly different” or “no difference” 

indicate there were no statistically 

detectable differences between the 

estimates being compared. 

Strengths and limitations of 

the data 

A major strength of NHIS data is 

that they were collected for a nationally 

representative sample of U.S. adults and 

children, thus allowing for the estimation 

of complementary health approach use 

for a wide variety of approaches. The 

large sample size also facilitates the 

investigation of the association between 

these approaches and a wide range 

of other self-reported characteristics 

included in NHIS, such as family income 

and age. 

NHIS questions have several 

limitations. First, they are dependent 

on respondents’ memory and their 

willingness to report accurately. Second, 

the collection of survey data at a single 

point in time results in an inability to 

produce consecutive annual prevalence 

estimates and can reduce the ability to 

produce reliable prevalence estimates 

for small population subgroups, because 

doing so could require a larger sample 

and more than 1 year of data. Finally, the 

total costs per person for natural product 

supplements and homeopathy were 

calculated by multiplying the amount 

spent at the most recent purchase by the 

number of purchases a year. Because 

data were not available for the exact cost 

at each purchase, and the most recent 

purchase may not have been typical 

of the respondent’s usual purchase of 

complementary products, the estimates 

may contain errors. 

Results 

Out-of-pocket expenditures 

on complementary health 

approaches 

●	 One in five individuals aged 4 

years and over in the United States 

had one or more expenditures for 

complementary health approaches. 

This equates to approximately 

59 million individuals (Table 1). 

●	 A total of 55.2 million adults 

(23.5%) had at least one expenditure 

for some complementary health 

approach. 

●	 A total of 4.1 million children (7.1%) 

had at least one expenditure for some 

complementary health approach. 

●	 Children and adults were significantly 

more likely to have had at least one 

expenditure for purchases of natural 

product supplements (4.2% and 

13.7%, respectively) than for either 

visits to a complementary practitioner 

(3.0% and 12.3%, respectively) or for 

self-care approaches 

(2.5% and 4.7%, respectively). 

Out-of-pocket expenditures 

on complementary health 

approaches, by type of 

approach 

●	 For individuals aged 4 years and 

over, $30.2 billion was spent 

out-of-pocket on complementary 

health approaches. Of this amount, 

more was spent on visits to 

complementary practitioners 

($14.7 billion) than for purchases of 

natural product supplements 

($12.8 billion) or self-care 

approaches ($2.7 billion) 

(Figure 1, Table 2). 

●	 Adults spent $28.3 billion 

out-of-pocket on complementary 

health approaches. Adults had more 

out-of-pocket expenditures for visits 

to complementary practitioners 

($14.1 billion) than for either natural 

product supplements 

($12.0 billion) or self-care 

approaches ($2.2 billion). 

●	 Almost $2 billion was spent 

out-of-pocket for children’s use of 

complementary health approaches. 

Similar amounts were spent 

out-of-pocket for children’s visits to 

complementary practitioners 

($0.6 billion), purchases of natural 

product supplements ($0.8 billion), 

and self-care approaches 

($0.5 billion). 

Mean annual per user 

out-of-pocket expenditures 

on complementary health 

approaches, by type of 

approach 

●	 For individuals aged 4 years and 

over, the mean annual per user 

out-of-pocket expenditure for all 

complementary health approaches 

was $510. The mean per user 

out-of-pocket expenditure for visits 

to a complementary practitioner 

($433) was significantly more than 

for purchases of natural product 

supplements ($368) or for self-care 

approaches ($257) (Table 3). 

●	 Adults had higher mean annual 

out-of-pocket expenditures on visits 

to complementary practitioners 

($442) than purchases of natural 

product supplements ($369) or 

self-care approaches ($241). 

●	 Adults had higher mean annual 

out-of-pocket expenditures for visits 

to complementary practitioners 

than children ($442 and $291, 

respectively). No difference between 

adults and children was observed 

for mean annual out-of-pocket 

expenditures on natural product 

supplements ($369 and $353, 

respectively) or self-care approaches 

($241 and $372, respectively). 

Total and mean annual 

per user out-of-pocket 

expenditures on 

complementary health 

approaches, by family 

income 

●	 Total out-of-pocket expenditures for 

complementary health approaches 

increased significantly as family 

income increased (Table 4). 

●	 Individuals with family incomes 

between $50,000 and $99,999 spent 
 

 

 

Page 4	 National Health Statistics Reports  Number 95  June 22, 2016 

 

 

 

 

Figure 1. Out-of-pocket expenditures for complementary health approaches among children 

aged 4–17 years and adults aged 18 and over: United States, 2012 

$10.1 billion on complementary 

health approaches (33.6% of the 

total out-of-pocket expenditures), 

while those with family incomes of 

at least $100,000 spent $11.0 billion 

(36.6% of the total out-of-pocket 

expenditures). 

●	 While the mean per user 

out-of-pocket expenditure for 

complementary health approaches 

was $435 for persons with family 

incomes less than $25,000, those 

with family incomes of $100,000 or 

more had mean per user expenditures 

of $590. 

Total and mean per user 

out-of-pocket expenditures 

on complementary health 

approaches, by family 

income and type of approach 

●	 Total out-of-pocket expenditures for 

visits to complementary practitioners 

increased significantly as family 

income increased (Table 5). 

●	 Persons with family incomes of 

$100,000 or more had more than four 

times the out-of-pocket expenditures 

for visits to complementary 

practitioners than persons with 

family incomes less than $25,000 

($6.2 billion and $1.3 billion, 

respectively). 

●	 Mean per user out-of-pocket 

expenditures for visits to 

complementary practitioners 

increased significantly as family 

income increased. 

●	 The mean per user out-of-pocket 

expenditure for visits to 

complementary practitioners was 

$314 for persons with family 

incomes less than $25,000 and $518 

for those with family incomes of 

$100,000 or more. 

●	 Total out-of-pocket expenditures 

for purchases of natural product 

supplements increased significantly 

as family income increased. 

●	 Individuals with family incomes 

between $50,000 and $99,999 spent 

the most on natural products 

($4.1 billion). This was about twice 

the amount spent by those with 

family incomes below $25,000 

($1.9 billion). 

●	 Family income level was not 

associated with the mean per user 

out-of-pocket expenditures for 

natural product supplements. 

●	 No relationship was observed 

between family income and 

either total or mean out-ofpocket expenditures on self-care 

approaches. 

Discussion 

Using data from the 2012 NHIS, 

it is estimated that the civilian 

noninstitutionalized U.S. population aged 

4 years and over spent about $30.2 billion 

out of pocket on visits to complementary 

practitioners and on purchases of related 

products, classes, and materials. This 

equates to 1.1% of total health care 

expenditures in the United States 

($2.82 trillion) and to 9.2% of 

out-of-pocket health care expenditures 

($328.8 billion) (18). Of this, the 

public had $12.8 billion in out-of-pocket 

expenditures for the purchase of 

natural product supplements, which is 

approximately 24% of the amount the 

public had in out-of-pocket expenditures 

for prescription drugs in 2012 ($54.1 

billion) (18). The public also had $14.7 

billion in out-of-pocket expenditures on 

visits to complementary practitioners, 

which is 29.6% of the amount in outof-pocket expenditures for conventional 

physician services ($49.6 billion) (18). 

Substantially more was spent on 

complementary health approaches for 

adults ($28.3 billion) than for children 

($1.9 billion). Several factors may 

account for this difference. First, there are 

more adults than children in the general 

population. Based on the 2010 Census, 

76% of the general population were 

adults and 18% were children aged 

4–17 years (19). Also, adults were more 

likely than children to use complementary 

health approaches (1,2). Third, as shown 

in Table 1, the percentage of children 

with an expenditure for complementary 

health approaches was about one-third 

that seen in adults (7.1% and 23.5%, 

respectively). When children do have 

an expenditure, the per person costs for 

visits to complementary practitioners 

is substantially less than expenditures 

for adults (Table 3). Finally, adults 

and children may use complementary 

health approaches for different reasons, 

which could account for the differences 

in expenditures between these groups. 

For instance, while 82.1% of adults 
National Health Statistics Reports  Number 95  June 22, 2016	 Page 5 

used chiropractors for a specific health 

condition (20), only about 58% of 

children used chiropractors to treat a 

specific health condition (21), with the 

remainder seeing a chiropractor for 

“wellness care” (22). It may be that visits 

for specific health conditions resulted 

in higher out-of-pocket costs because of 

increased use of diagnostic procedures by 

complementary practitioners, including 

radiographic imaging (23). 

It has been previously determined 

that prevalence rates for the use of 

complementary health approaches 

increased as family income increased 

(24). This analysis shows that 

out-of-pocket expenditures on 

complementary health approaches also 

increased as family income increased. In 

particular, those with the highest family 

income had more than four times higher 

mean per user out-of-pocket expenditures 

for visits to complementary practitioners 

than those with the lowest family 

income. These data are not unexpected 

given that most individuals do not have 

health insurance coverage for visits to 

complementary practitioners (25), and 

costs per visit can be $100 or more (10), 

making it difficult for those with lower 

incomes to afford such care. 

Out-of-pocket expenditures made 

by adults were previously reported 

using data from the 2007 NHIS (10,11). 

However, the 2007 survey varied from 

the 2012 NHIS in several ways that 

have been previously documented (14), 

including only a partial overlap in the 

list of complementary health approaches 

examined and the use of different 

questions to elicit data on out-of-pocket 

expenditures. Thus, it is not appropriate 

to make direct comparisons between 

the calculated expenditures in the two 

surveys. 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. 

In summary, the 2012 NHIS data 

indicate that the U.S. public spent 

billions of dollars out of pocket on 

complementary health approaches. 

These expenditures, although a small 

fraction of total health care spending 

in the U.S., constitute a substantial part 

of out-of-pocket health care costs and 

are comparable to out-of-pocket costs 

for conventional physician services and 

prescription drug use. 

References 

1.	 Clarke TC, Black LI, Stussman BJ, et al. 

Trends in the use of complementary health 

approaches among adults: United States, 

2002–2012. National health statistics 

reports; no 79. Hyattsville, MD: National 

Center for Health Statistics. 2015. 

2.	 Black LI, Clarke TC, Barnes PM, et al. 

Use of complementary health approaches 

among children aged 4–17 years in the 

United States: National Health Interview 

Survey, 2007–2012. National health 

statistics reports; no 78. Hyattsville, MD: 

National Center for Health Statistics. 

2015. 

3.	 Davis MA, Martin BI, Coulter ID, Weeks 

WB. US spending on complementary 

and alternative medicine during 2002–08 

plateaued, suggesting role in reformed 

health system. Health Aff (Millwood) 

32(1):45–52. 2013. 

4.	 Egede LE, Ye X, Zheng D, Silverstein 

MD. The prevalence and pattern of 

complementary and alternative medicine 

use in individuals with diabetes. Diabetes 

Care 25(2):324–9. 2002. 

5.		 Eisenberg DM, Kessler RC, Foster C, 

Norlock FE, Calkins DR, Delbanco TL. 

Unconventional medicine in the United 

States. Prevalence, costs, and patterns of 

use. N Engl J Med 328(4):246–52. 1993. 

6.	 Eisenberg DM, Davis RB, Ettner SL, 

Appel S, Wilkey S, Van Rompay M, 

Kessler RC. Trends in alternative 

medicine use in the United States, 

1990–1997: Results of a follow-up 

national survey. JAMA 280(18):1569–75. 

1998. 

7.	 Lafferty WE, Bellas A, Corage Baden A, 

Tyree PT, Standish LJ, Patterson R. The 

use of complementary and alternative 

medical providers by insured cancer 

patients in Washington state. Cancer 

100(7):1522–30. 2004. 

8.	 Lind BK, Lafferty WE, Tyree PT, 

Sherman KJ, Deyo RA, Cherkin DC. The 

role of alternative medical providers for 

the outpatient treatment of insured patients 

with back pain. Spine (Phila Pa 1976) 

30(12):1454–9. 2005. 

9.		 Lind BK, Lafferty WE, Tyree PT, 

Diehr PK, Grembowski DE. Use of 

complementary and alternative medicine 

providers by fibromyalgia patients under 

insurance coverage. Arthritis Rheum 

57(1):71–6. 2007. 

10. Nahin RL, Barnes PM, Stussman BJ, 

Bloom B. Costs of complementary 

and alternative medicine (CAM) and 

frequency of visits to CAM practitioners: 

United States, 2007. National health 

statistics reports; no18. Hyattsville, MD: 

National Center for Health Statistics. 

2009. 

11.	 Nahin RL, Stussman BJ, Herman PM. 

Out-of-pocket expenditures on 

complementary health approaches 

associated with painful health conditions 

in a nationally representative adult 

sample. J Pain 16(11):1147–62. 2015. 

12. Ramsey SD, Spencer AC, Topolski TD, 

Belza B, Patrick DL. Use of alternative 

therapies by older adults with osteoarthritis. 

Arthritis Rheum 45(3):222–7. 2001. 

13. Institute of Medicine (US) Committee 

on the Use of Complementary and 

Alternative Medicine by the American 

Public. Complementary and alternative 

medicine in the United States. 

Washington, DC: National Academies 

Press. 2005. 

14. Stussman BJ, Bethell CD, Gray C, Nahin 

RL. Development of the adult and child 

complementary medicine questionnaires 

fielded on the National Health Interview 

Survey. BMC Complement Altern Med 

13:328. 2013. 

15. National Center for Health Statistics. 2012 

National Health Interview Survey (NHIS): 

Public use data release. NHIS survey 

description. 2012. Available from: ftp:// 

ftp.cdc.gov/pub/Health_Statistics/ NCHS/ 

Dataset_Documentation/NHIS/2012/ 

srvydesc.pdf. 

16. Parsons VL, Moriarity C, Jonas K, et al. 

Design and estimation for the National 

Health Interview Survey, 2006–2015. 

National Center for Health Statistics. 

Vital Health Stat 2(165). 2014. 

17. RTI International. SUDAAN (Release 

11.0.0) [computer software]. 2009. 

18. Center for Medicare & Medicaid Services. 

National health expenditures by type of 

service and source of funds: 1960–2014. 

Baltimore, MD. Available from: http:// 

www.cms.gov/Research-Statistics-Dataand-Systems/Statistics-Trends-andReports/NationalHealthExpendData/ 

NationalHealthAccountsHistorical.html. 

19. Howden LM, Meyer JA. Age and sex 

composition: 2010. 2010 Census Briefs. 

Suitland, MD: U.S. Census Bureau. 2011. 

20. Hawk C, Ndetan H, Evans MW Jr. 

Potential role of complementary and 

alternative health care providers in chronic 

disease prevention and health promotion: 

An analysis of National Health Interview 

Survey data. Prev Med 54(1):18–22. 2012. 
Page 6 National Health Statistics Reports  Number 95  June 22, 2016 

21. Ndetan H, Evans MW Jr, Hawk C, 

Walker C. Chiropractic or osteopathic 

manipulation for children in the United 

States: An analysis of data from the 2007 

National Health Interview Survey. J Altern 

Complement Med 18(4):347–53. 2012. 

22. Alcantara J, Ohm J, Kunz D. The 

chiropractic care of children. J Altern 

Complement Med 16(6):621–6. 2010. 

23. Mootz RD, Cherkin DC, Odegard 

CE, Eisenberg DM, Barassi JP, Deyo 

RA. Characteristics of chiropractic 

practitioners, patients, and encounters in 

Massachusetts and Arizona. 

J Manipulative Physiol Ther 28(9):645– 

53. 2005. 

24. Barnes PM, Powell-Griner E, McFann K, 

Nahin RL. Complementary and alternative 

medicine use among adults: United 

States, 2002. Advance data from vital 

and health statistics; no 343. Hyattsville, 

MD: National Center for Health Statistics. 

2004. 

25. Nahin RL, Barnes PM, and Stussman BJ. 

Insurance coverage for complementary 

health approaches among adult users: 

United States, 2002 and 2012. NCHS data 

brief, no 235. Hyattsville, MD: National 

Center for Health Statistics. 2016. 
 

 

 

 

National Health Statistics Reports  Number 95  June 22, 2016 Page 7 

Table 1. Frequencies and percentages of expenditures on complementary health approaches in the last 12 months for children aged 4–17 

years and adults aged 18 and over, by type of expenditure: United States, 2012 

Aged 4 years and over Child Adult 

Type of expenditure 

Weighted n 

(millions) 

Weighted 

percent 

Standard 

error 

Weighted n 

(millions) 

Weighted 

percent 

Standard 

error 

Weighted n 

(millions) 

Weighted 

percent 

Standard 

error 

Any complementary health approach1 . . . . . . . . . 59.3 20.3 0.31 4.1 7.1 0.33 55.2 23.5 0.35 

Practitioner visits2 . . . . . . . . . . . . . . . . . . . . . . . . 34.0 3

10.5 0.22 2.1 3.0 0.24 28.9 312.3 0.25 

Natural product supplements4

 . . . . . . . . . . . . . . . 34.8 511.7 0.25 2.3 54.2 0.23 32.1 513.7 0.29 

Self-care approaches6 . . . . . . . . . . . . . . . . . . . . . 10.4 4.2 0.13 1.3 2.5 0.20 11.0 4.7 0.16 

1

Includes visits to complementary approach practitioners, purchases of natural product supplements, and costs associated with self-care approaches.
 

2

Includes visits to practitioners of acupuncture, Ayurveda, homeopathy, naturopathy, chelation therapy, natural product supplements, special diets, chiropractic, massage, movement therapies, 


biofeedback, mind-body therapies, hypnosis, energy healing therapy, and craniosacral therapy; visits to traditional healers; instructors of yoga, tai chi, and qi gong; teachers of movement therapies;
 

and classes for mind-body therapies.
 

3

Significantly different from self-care approaches using the z test (p < 0.05).
 4

Includes acai pills or gelcaps, bee pollen (or other bee products), chondroitin, co-enzyme Q10 (CoQ10), cranberry pills or capsules, digestive enzymes (lactaid), echinacea, fish oil (or omega 3, 


DHA, or EPA fatty acid), garlic supplements, ginkgo biloba, ginseng, glucosamine, green tea pills or EGCG pills, melatonin, milk thistle (silymarin), methylsulfonylmethane, probiotics or prebiotics, 


SAM-e, saw palmetto, valerian, and other herbs or nonvitamin supplements.
 

5

Significantly different from both practitioner visits and self-care approaches using the z test (p < 0.05).
 6

Includes homeopathic medicine and self-help materials (e.g., books, CDs, videotapes) for acupuncture, Ayurveda, homeopathy, naturopathy, traditional healers, chelation therapy, natural product 


supplements, special diets, chiropractic, massage, movement therapies, biofeedback, mind-body therapies, hypnosis, yoga, tai chi, qi gong, energy healing therapy, and craniosacral therapy.
 

NOTE: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population.
 

SOURCE: NCHS, National Health Interview Survey, 2012.
 

Table 2. Annual out-of-pocket expenditures on complementary health approaches for children aged 4–17 years and adults aged 18 and 

over, by type of expenditure: United States, 2012 

Aged 4 years and over Child Adult 

Out-of-pocket Out-of-pocket Out-of-pocket 

expenditures expenditures expenditures 

Type of expenditure (billions) (95% CI) Percent of total (billions) (95% CI) Percent of total (billions) (95% CI) Percent of total 

Any complementary health approach1 . . . . . . . . . . . . 30.2 (28.4, 32.0) 100.0 1.9 (1.3, 2.5) 100.0 28.3 (26.6, 30.0) 100.0 

Practitioner visits2 . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.7 (13.8, 15.6) 48.8 0.6 (0.5, 0.7) 31.9 3

14.1 (13.2, 15.0) 49.9 

Natural product supplements4

 . . . . . . . . . . . . . . . . . . 12.8 (11.5, 14.1) 42.4 0.8 (0.5, 1.1) 43.1 512.0 (10.8, 13.2) 42.4 

Self-care approaches6 . . . . . . . . . . . . . . . . . . . . . . . . 2.7 (1.9, 3.5) 8.8 0.5 (0.1, 0.9) 25.0 2.2 (1.5, 2.9) 7.7 

1

Includes visits to complementary approach practitioners, purchases of natural product supplements, and costs associated with self-care approaches.
 

2

Includes visits to practitioners of acupuncture, Ayurveda, homeopathy, naturopathy, chelation therapy, natural product supplements, special diets, chiropractic, massage, movement therapies,
 

biofeedback, mind-body therapies, hypnosis, energy healing therapy, craniosacral therapy; visits to traditional healers; instructors of yoga, tai chi, and qi gong; teachers of movement therapies;
 

and classes for mind-body therapies.
 

3

Signifcantly different from natural product supplements and self-care approaches using the ANOVA Tukey post-hoc test (p < 0.05).
 4

Includes acai pills or gelcaps, bee pollen (or other bee products), chondroitin, co-enzyme Q10 (CoQ10), cranberry pills or capsules, digestive enzymes (lactaid), echinacea, fish oil (or omega 3, DHA,
 

or EPA fatty acid), garlic supplements, ginkgo biloba, ginseng, glucosamine, green tea pills or EGCG pills, melatonin, milk thistle (silymarin), methylsulfonylmethane, probiotics or prebiotics, SAM-e,
 

saw palmetto, valerian, and other herbs or nonvitamin supplements.
 

5

Significantly different from self-care approaches using the ANOVA Tukey post-hoc test (p < 0.05).
 6

Includes homeopathic medicine and self-help materials (e.g., books, CDs, videotapes) for acupuncture, Ayurveda, homeopathy, naturopathy, traditional healers, chelation therapy, natural product 


supplements, special diets, chiropractic, massage, movement therapies, biofeedback, mind-body therapies, hypnosis, yoga, tai chi, qi gong, energy healing therapy, and craniosacral therapy.
 

NOTES: CI is confidence interval. Estimates are based on household interviews of a sample of the civilian noninstitutionalized population.
 

SOURCE: NCHS, National Health Interview Survey, 2012.
 
 

 

 

Page 8 National Health Statistics Reports  Number 95  June 22, 2016 

Table 3. Mean per user out-of-pocket expenditures on complementary health approaches for children aged 4–17 years and adults aged 18 

and over, by type of expenditure: United States, 2012 

Aged 4 years and over Child Adult 

Child compared 

with adult 

Type of expenditure 

Weighted number 

of users with 

an 

expenditure 

(millions) 

Mean per user 

out-of-pocket 

expenditures 

(dollars) 

(95% CI) 

Weighted number 

of users with 

an 

expenditure 

(millions) 

Mean per user 

out-of-pocket 

expenditures 

(dollars) 

(95% CI) 

Weighted number 

of users with 

an 

expenditure 

(millions) 

Mean per user 

out-of-pocket 

expenditures 

(dollars) 

(95% CI) p value1 

Any complementary health approach2 . . . . . . 59.3 510 (478, 542) 4.1 455 (308, 601) 55.2 514 (483, 545) p > 0.05 

Practitioner visits3 . . . . . . . . . . . . . . . . . . . . . 34.0 4

433 (406, 460) 2.1 291 (231, 351) 28.9 4442 (414, 470) p < 0.01 

Natural product supplements5

 . . . . . . . . . . . . 34.8 6368 (331, 405) 2.3 353 (211, 495) 32.1 6369 (330, 408) p > 0.05 

Self-care approaches7 . . . . . . . . . . . . . . . . . . 10.4 257 (220, 334) 1.4 372 (96, 648) 11.0 241 (184, 298) p > 0.05 

1

Based on t test.
 2

Includes visits to complementary approach practitioners, purchases of natural product supplements, and costs associated with self-care approaches.
 

3

Includes visits to practitioners of acupuncture, Ayurveda, homeopathy, naturopathy, chelation therapy, natural product supplements, special diets, chiropractic, massage, movement therapies, 


biofeedback, mind-body therapies, hypnosis, energy healing therapy, and craniosacral therapy; visits to traditional healers; instructors of yoga, tai chi, and qi gong; teachers of movement therapies;
 

and classes for mind-body therapies.
 

4

Significantly different from both natural product supplements and self-care approaches using the ANOVA Tukey post-hoc test (p < 0.05).
 5

Includes acai pills or gelcaps, bee pollen (or other bee products), chondroitin, co-enzyme Q10 (CoQ10), cranberry pills or capsules, digestive enzymes (lactaid), echinacea, fish oil (or omega 3, 


DHA, or EPA fatty acid), garlic supplements, ginkgo biloba, ginseng, glucosamine, green tea pills or EGCG pills, melatonin, milk thistle (silymarin), methylsulfonylmethane, probiotics or prebiotics, 


SAM-e, saw palmetto, valerian, and other herbs or nonvitamin supplements.
 

6

Significantly different from self-care approaches using the ANOVA Tukey post-hoc test (p < 0.05).
 7

Includes homeopathic medicine and self-help materials (e.g., books, CDs, videotapes) for acupuncture, Ayurveda, homeopathy, naturopathy, traditional healers, chelation therapy, natural product 


supplements, special diets, chiropractic, massage, movement therapies, biofeedback, mind-body therapies, hypnosis, yoga, tai chi, qi gong, energy healing therapy, and craniosacral therapy.
 

NOTES: CI is confidence interval. Estimates are based on household interviews of a sample of the civilian noninstitutionalized population.
 

SOURCE: NCHS, National Health Interview Survey, 2012.
 

Table 4. Total and mean per user out-of-pocket expenditures on complementary health approaches for children aged 4–17 years and adults 

aged 18 and over, by family income: United States, 2012 

Total out-of-pocket Mean per user 

expenditures (billions)1 Percent of total out-of-pocket expenditures 

Family income Weighted n (millions) (95% CI) out-of-pocket expenditures (dollars)1

 (95% CI) 

$0–$24,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.0 3.5 (2.8, 4.2) 11.6 435 (345, 525) 

$25,000–$49,999. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.4 5.5 (4.7, 6.3) 18.3 448 (382, 514) 

$50,000–$99,999. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.1 10.1 (9.2, 11.0) 33.6 505 (458, 552) 

At or above $100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 18.6 11.0 (9.7, 12.3) 36.6 590 (520, 660) 

1

p value, test for trend, (p < 0.01). Based on linear regression with expenditures as the dependent variable and family income as the independent variable.
 

NOTES: CI is confidence interval. Estimates are based on household interviews of a sample of the civilian noninstitutionalized population.
 

SOURCE: NCHS, National Health Interview Survey, 2012.
 

Table 5. Total and mean per user out-of-pocket expenditures on complementary health approaches for children aged 4–17 years and adults 

aged 18 and over, by family income and type of approach: United States, 2012 

Practitioner visits1 Natural product supplements2 Self-care approaches3 

Family income 

Weighted n 

(millions) 

Total 

out-of-pocket 

expenditures 

(billions)4 

(95% CI) 

Mean per user 

out-of-pocket 

expenditures 

(dollars)4 

(95% CI) 

Weighted n 

(millions) 

Total 

out-of-pocket 

expenditures 

(billions)4 

(95% CI) 

Mean per user 

out-of-pocket 

expenditures 

(dollars)5 

(95% CI) 

Weighted n 

(millions) 

Total 

out-of-pocket 

expenditures 

(billions)5 

(95% CI) 

Mean per user 

out-of-pocket 

expenditures 

(dollars)5 

(95% CI) 

$0–$24,999 . . . . . . . . . . . . . . . . . 4.0 1.3 (1.1, 1.5) 314 (267, 361) 4.9 1.9 (1.2, 2.1) 389 (256, 522) 1.4 0.3 (0.1, 0.5) 231 (65, 397) 

$25,000–$49,999. . . . . . . . . . . . . 6.1 2.1 (1.8, 2.4) 351 (300, 402) 8.0 2.9 (2.3, 3.5) 362 (281, 443) 2.1 0.5 (0.2, 0.8) 240 (79, 401) 

$50,000–$99,999. . . . . . . . . . . . . 11.9 5.1 (4.5, 5.7) 430 (382, 478) 11.6 4.1 (3.4, 4.7) 355 (306, 404) 3.6 0.9 (0.5, 1.3) 252 (117, 369) 

At or above $100,000 . . . . . . . . . 11.9 6.2 (5.5, 6.9) 518 (456, 580) 10.3 3.9 (2.6, 4.5) 377 (307, 447) 3.3 0.9 (0.4, 1.4) 284 (125, 439) 

1

Includes visits to practitioners of acupuncture, Ayurveda, homeopathy, naturopathy, chelation therapy, natural product supplements, special diets, chiropractic, massage, movement therapies, 


biofeedback, mind-body therapies, hypnosis, energy healing therapy, and craniosacral therapy; visits to traditional healers; instructors of yoga, tai chi, and qi gong; teachers of movement therapies;
 

and classes for mind-body therapies.
 

2

Includes acai pills or gelcaps, bee pollen and (or other bee products), chondroitin, co-enzyme Q10 (CoQ10), cranberry pills or capsules, digestive enzymes (lactaid), echinacea, fish oil (or omega 3,
 

DHA, or EPA fatty acid), garlic supplements, ginkgo biloba, ginseng, glucosamine, green tea pills or EGCG pills, melatonin, milk thistle (silymarin), methylsulfonylmethane, probiotics or prebiotics,
 

SAM-e, saw palmetto, valerian, and other herbs or nonvitamin supplements.
 

3

Includes homeopathic medicine and self-help materials (e.g., books, CDs, videotapes) for acupuncture, Ayurveda, homeopathy, naturopathy, traditional healers, chelation therapy, natural product 


supplements, special diets, chiropractic, massage, movement therapies, biofeedback, mind-body therapies, hypnosis, yoga, tai chi, qi gong, energy healing therapy, and craniosacral therapy.
 

4

p value, test for trend, (p < 0.001). Based on linear regression with expenditures as the dependent variable and family income as the independent variable.
 5

Not significant (p > 0.05).
 

NOTES: CI is confidence interval. Estimates are based on household interviews of a sample of the civilian noninstitutionalized population.
 

SOURCE: NCHS, National Health Interview Survey, 2012.
 
National Health Statistics Reports  Number 95  June 22, 2016 Page 9 

Technical Notes 

Sample design 

The National Health Interview 

Survey (NHIS) is a cross-sectional 

household interview survey of the U.S. 

civilian noninstitutionalized population. 

Data are collected continuously 

throughout the year in all 50 states and 

the District of Columbia. NHIS uses a 

multistage clustered sample design to 

produce national estimates for a variety 

of health indicators. Information on 

basic health topics is collected for all 

household members, if necessary by 

proxy, from one adult family member. 

Additional information is collected for 

one randomly selected adult and one 

randomly selected child in each family. 

Self-response is required for the Sample 

Adult questionnaire, except in rare cases 

where sample adults are physically or 

mentally incapable of responding for 

themselves. Interviews are conducted 

in the home using computer-assisted 

personal interview techniques, with 

telephone interviewing permitted for 

follow-up if necessary. Starting in 

2006, the sample design included Asian 

persons in the oversampling of minority 

populations in NHIS. Previously, only 

households with non-Hispanic black and 

Hispanic persons were oversampled. 

Sample size and response 

rate 

In 2012, NHIS interviews were 

completed in 42,366 households, which 

yielded 108,131 persons in 43,345 

families; the household response 

rate was 77.6%. The Sample Adult 

questionnaire was completed for 34,525 

adults. The final response rate (which 

takes into account household and family 

nonresponse) for the 2012 Sample Adult 

files was 61.2% (12). The Sample Child 

questionnaire was completed for 13,275 

children. The final response rate (which 

takes into account household and family 

nonresponse) for the 2012 Sample Child 

files was 69.7% (12). 

Tests of significance 

Statistical reliability and 

hypothesis tests 

Statistical tests performed to 

assess the significance of differences in 

prevalence estimates were two-tailed 

tests. The test statistic used to determine 

statistical significance of the difference 

| Xa – Xb |

Z = 2 √Sa

2 + Sb 

between two percentages was 

where X a and Xb are the two percentages 

being compared, and S a and Sb are the 

SUDAAN-calculated standard errors of 

those percentages. 

Two-tailed t tests were used to 

assess the significance of differences in 

continuous data, such as expenditures. 

Linear regression was used to assess 

trends. 

The critical value used for all 

two-sided tests at the 0.05 level of 

significance was 1.96. No adjustments 

were made for multiple comparisons. 

Relative standard error 

Standard errors, produced by using 

the SUDAAN statistical package, are 

shown for all percentages in the tables. 

Estimates with a relative standard error 

(RSE) greater than 30% and less than 

or equal to 50% should be used with 

caution as they do not meet standards of 

reliability or precision. Estimates with 

an RSE greater than 50% are not shown. 

RSEs are calculated as follows: 

RSE = (SE/Est)100 

where SE is the standard error of 

the estimate, and Est is the estimate 

(percentage). 

Definition of selected terms 

Definition of terms related to broad 

categories of complementary 

health approaches 

All complementary health 

approaches—Includes visits to 

complementary approach practitioners, 

purchases of natural product 

supplements, and costs associated with 

self-care approaches (see definitions that 

follow). For more information about 

specific health approaches, visit the 

National Center for Complementary and 

Integrative Health website at: https:// 

www.nih.gov/about-nih/what-we-do/nihalmanac/national-center-complementaryintegrative-health-nccih. 

Visits to complementary approach 

practitioners—Includes visits to 

practitioners of acupuncture, Ayurveda, 

homeopathy, naturopathy, chelation 

therapy, natural product supplements, 

special diets, chiropractic, massage, 

movement therapies, biofeedback, 

mind-body therapies, hypnosis, energy 

healing therapy, and craniosacral therapy; 

visits to traditional healers; instructors 

of yoga, tai chi, and qi gong; teachers 

of movement therapies; and classes for 

mind-body therapies (see definitions that 

follow for details on specific approaches). 

Natural product supplements— 

Includes acai pills or gelcaps, bee pollen 

(or other bee products), chondroitin, 

co-enzyme Q10 (CoQ10), cranberry 

pills or capsules, digestive enzymes 

(lactaid), echinacea, fish oil (or omega 

3, DHA, or EPA fatty acid), garlic 

supplements, ginkgo biloba, ginseng, 

glucosamine, green tea pills or EGCG 

pills, melatonin, milk thistle (silymarin), 

methylsulfonylmethane, probiotics 

or prebiotics, SAM-e, saw palmetto, 

valerian, and other herbs or nonvitamin 

supplements (see definitions that follow 

for details on specific approaches). 

Self-care approaches—Includes 

homeopathic medicine and self-help 

materials (e.g., books, CDs, videotapes) 

for acupuncture, Ayurveda, homeopathy, 

naturopathy, traditional healers, 

chelation therapy, natural product 

supplements, special diets, chiropractic, 

massage, movement therapies, 

biofeedback, mind-body therapies, 

hypnosis, yoga, tai chi, qi gong, energy 

healing therapy, and craniosacral 

therapy. 
Page 10 National Health Statistics Reports  Number 95  June 22, 2016 

Definition of terms related to 

individual complementary health 

approaches 

Acupuncture—A family of 

procedures involving stimulation of 

anatomical points on the body by a 

variety of techniques. American practices 

of acupuncture incorporate medical 

traditions from China, Japan, Korea, 

and other countries. The acupuncture 

technique that has been most studied 

scientifically involves penetrating the 

skin with thin, solid, metallic needles 

that are manipulated by the hands or by 

electrical stimulation. 

Alternative provider or 

practitioner—Someone who is 

knowledgeable about a specific 

alternative health practice. This person 

provides care or gives advice about its 

use and usually receives payment for 

their services. For some practices, the 

provider may have received formal 

training and has been certified by a 

licensing board or related professional 

association. For example, a practitioner 

of biofeedback (biofeedback therapist) 

has usually received training in 

psychology and physiology and may be 

certified by the Biofeedback Certification 

Institute of America. 

Ayurveda—A system of medicine 

that originated in India several thousand 

years ago. In the United States, Ayurveda 

is considered a type of complementary 

and alternative medicine and a whole 

medical system. As with other such 

systems, it is based on theories of health 

and illness and on ways to prevent, 

manage, or treat health problems. 

Ayurveda aims to integrate and balance 

the body, mind, and spirit (thus, some 

view it as “holistic”). This balance is 

believed to lead to contentment and 

health and to help prevent illness. 

However, Ayurveda also proposes 

treatments for specific health problems, 

whether they are physical or mental. A 

chief aim of Ayurvedic practices is to 

cleanse the body of substances that can 

cause disease, and this is believed to help 

reestablish harmony and balance. 

Biofeedback—A technique that uses 

simple electronic devices to teach clients 

how to consciously regulate bodily 

functions, such as breathing, heart rate, 

and blood pressure, to improve overall 

health. Biofeedback is used to reduce 

stress, eliminate headaches, recondition 

injured muscles, control asthma attacks, 

and relieve pain. 

Chiropractic manipulation—A 

form of health care that focuses on 

the relationship between the body’s 

structure, primarily of the spine, and 

function. Doctors of chiropractic, 

who are also called chiropractors or 

chiropractic physicians, use a type of 

hands-on therapy called manipulation 

(or adjustment) as their core clinical 

procedure. 

Craniosacral therapy—Practitioners 

of this body-based therapy use light touch 

and manipulation focused on the skull 

and spine, with the intent of sensing and 

removing what they refer to as blockages 

or imbalances that may be contributing to 

a health condition. 

Energy healing therapy—Involves 

the channeling of healing energy through 

the hands of a practitioner into the 

client’s body to restore a normal energy 

balance and, therefore, health. Energy 

healing therapy has been used to treat 

a wide variety of ailments and health 

problems and is often used in conjunction 

with other alternative and conventional 

medical treatments. 

Guided imagery—Used for healing 

or health maintenance and involves a 

series of relaxation techniques followed 

by the visualization of detailed images, 

usually calm and peaceful in nature. If 

used for treatment, the individual will 

visualize their body free of the specific 

problem or condition. Sessions are 

typically 20 to 30 minutes in length, and 

may be practiced several times a week. 

Homeopathy—A system of medical 

practices based on the theory that any 

substance that can produce symptoms of 

disease or illness in a healthy person can 

cure those symptoms in a sick person. 

For example, someone suffering from 

insomnia may be given a homeopathic 

dose of coffee. Administered in diluted 

form, homeopathic treatments are derived 

from many natural sources, including 

plants, metals, and minerals. Practitioners 

of homeopathy receive formal training 

in the diagnosis and treatment of health 

conditions based on homeopathic 

principles. 

Hypnosis—An altered state 

of consciousness characterized by 

increased responsiveness to suggestion. 

This hypnotic state is attained by first 

relaxing the body, then shifting attention 

toward a narrow range of objects or 

ideas as suggested by the hypnotist or 

hypnotherapist. The procedure is used 

to affect positive changes and to treat 

numerous health conditions including 

ulcers, chronic pain, respiratory ailments, 

stress, and headaches. 

Massage—Therapists manipulate 

muscle and connective tissue to enhance 

function of those tissues and promote 

relaxation and wellbeing. 

Meditation—Refers to a group of 

techniques, most of which started in 

Eastern religious or spiritual traditions. 

In meditation, a person learns to focus 

their attention and suspend the stream 

of thoughts that normally occupy the 

mind. This practice is believed to result 

in a state of greater physical relaxation, 

mental calmness, and psychological 

balance. Practicing meditation can 

change how a person relates to the flow 

of emotions and thoughts in the mind. 

Naturopathy—An alternative 

medical system based on the belief that 

there is a healing power in the body 

that establishes, maintains, and restores 

health. Practitioners work with the patient 

with a goal of supporting this power 

through treatments such as nutrition and 

lifestyle counseling, dietary supplements, 

medicinal plants, exercise, homeopathy, 

and treatments from traditional Chinese 

medicine. 

Natural product supplements— 

Nonvitamin, nonmineral dietary 

supplements are taken by mouth and 

contain a dietary ingredient intended to 

supplement the diet other than vitamins 

and minerals. Examples include herbs 

or herbal medicine (as single herbs or 

mixtures), other botanical products 

such as soy or flax products, and 

dietary substances such as enzymes and 

glandulars. Among the most popular 

are echinacea, ginkgo biloba, ginseng, 

feverfew, garlic, kava kava, and saw 

palmetto. Garlic, for example, has 

been used to treat fevers, sore throats, 

digestive ailments, hardening of the 

arteries, and other health problems and 

conditions. 
National Health Statistics Reports  Number 95  June 22, 2016 Page 11 

Osteopathic manipulation—A fullbody system of hands-on techniques 

to alleviate pain, restore function, and 

promote health and wellbeing. 

Progressive relaxation—A technique 

used to relieve tension and stress by 

systematically tensing and relaxing 

successive muscle groups. 

Qi gong—An ancient Chinese 

discipline combining the use of gentle 

physical movements, mental focus, 

and deep breathing directed toward 

specific parts of the body. Performed in 

repetitions, the exercises are normally 

performed two or more times a week for 

30 minutes at a time. 

Tai chi—A mind-body practice 

that originated in China as a martial 

art. A person doing tai chi moves his 

or her body slowly and gently, while 

breathing deeply and meditating (tai 

chi is sometimes called “moving 

meditation”). Many practitioners believe 

that tai chi helps the flow throughout the 

body of a proposed vital energy called 

“qi.” A person practicing tai chi moves 

his or her body in a slow, relaxed, and 

graceful series of movements. It can be 

practiced independently or in a group. 

The movements make up what are called 

forms or routines. 

Traditional healer—Someone 

who employs any one of a number 

of ancient medical practices that are 

based on indigenous theories, beliefs, 

and experiences handed down from 

generation to generation, often orally. 

The methods employed by each type of 

traditional healer have evolved to reflect 

the different philosophical backgrounds 

and cultural origins of the healer. 

Yoga—Combines breathing 

exercises, physical postures, and 

meditation to calm the nervous system 

and balance the body, mind, and spirit. 

Usually performed in classes, sessions 

are conducted once a week or more. 
National Health Statistics Reports  Number 95  June 22, 2016

For more NCHS NHSRs, visit: 

http://www.cdc.gov/nchs/products/nhsr.htm. 

U.S. DEPARTMENT OF 

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road, Room 5419

Hyattsville, MD 20782–2064

FIRST CLASS MAIL

POSTAGE & FEES PAID

CDC/NCHS 

PERMIT NO. G-284

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

Suggested citation 

Nahin RL, Barnes PM, Stussman BJ. 

Expenditures on complementary health 

approaches: United States, 2012. National 

health statistics reports; no 95. Hyattsville, MD: 

National Center for Health Statistics. 2016. 

Copyright information 

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated. 

National Center for Health Statistics 

Charles J. Rothwell, M.S., M.B.A., Director 

Jennifer H. Madans, Ph.D., Associate Director 

for Science 

Division of Research and Methodology 

Nathaniel Schenker, Ph.D., Director
 

Donald Malec, Ph.D., Associate Director for 


Science
 

For e-mail updates on NCHS publication releases, subscribe online at: http://www.cdc.gov/nchs/govdelivery.htm.
 

For questions or general information about NCHS: Tel: 1–800–CDC–INFO (1–800–232–4636) • TTY: 1–888–232–6348
 

Internet: http://www.cdc.gov/nchs • Online request form: http://www.cdc.gov/info
 

DHHS Publication No. 2016–1250 • CS265603