This page provides ONZ members with a full update on one of the most significant research projects ever undertaken for the osteopathic profession in Aotearoa New Zealand - a large-scale analysis of ACC data that will, for the first time, provide robust economic evidence for the value osteopathy delivers within the New Zealand health system.
This is members-only information. We are sharing it in full because this work is being done on your behalf, and because understanding it matters for how you engage with conversations about ACC funding, the profession's future, and your own practice.
Two key events in 2023 made the urgency of this work impossible to ignore.
The first was the publication of the ACC evidence-based review of osteopathy, which included two clear recommendations directed at the profession a need for better quality osteopathic research, and a need for research focused on long-term outcomes rather than short-term ones only. The review also noted that ACC is actively assessing how to use its findings to improve client rehabilitation outcomes - a statement that signals the profession's funding position is not fixed, and that evidence will shape what comes next.
The second was a presentation at an Osteopathic Council conference by Dr Martin Chadwick of the Ministry of Health. His message was direct: before osteopathy can explore any funding opportunities within the public health system, the profession must first provide evidence of cost effectiveness. When asked from the floor whose responsibility it was to produce that evidence, his answer was unambiguous - it is not the Ministry of Health's responsibility. It is ours.
As Dr Kesh Sampath put it: the writing is on the wall.
ACC funds more than 100,000 osteopathy claims each year and is the single largest funder of osteopathic care in New Zealand. Yet until now, the profession has lacked the hard economic data needed to answer the most fundamental question funders ask: what value does osteopathy actually deliver, and at what cost? Every conversation ONZ has had with ACC about fees, funding, and the profession's role in musculoskeletal rehabilitation has been conducted without that evidence base.
This project is designed to change that.
After two and a half years of negotiation, and following ethics approval in February 2025, Associate Professor Dr Kesh Sampath and Professor Nathan Berg at the University of Otago successfully obtained a large ACC-approved dataset for analysis.
The dataset contains millions of data points across 25 gigabytes of ACC claims information - one of the most comprehensive osteopathy-specific datasets ever made available for research in New Zealand.
Due to the volume and complexity of the work, the current analysis is focused on lumbar and thoracic spine conditions - the body sites that represent the highest proportion of ACC-funded osteopathy claims.
The team is conducting an exhaustive analysis of this dataset. The objectives are to:
This analysis will give ONZ - and by extension every practising osteopath in New Zealand - evidence-based answers to the questions ACC and the Ministry of Health are most likely to ask.
While the large individual-level dataset analysis is still underway, the research team has already extracted meaningful findings from aggregate ACC data. Here is what the early picture shows:
Osteopaths are growing, not shrinking
Unlike physiotherapy and chiropractic - both of which peaked in 2019 and have not fully returned to their pre-pandemic trend lines - osteopathic payment counts have increased every single year. In 2023, osteopaths received 124,013 ACC-funded payments, representing 13.1% of all payments across the top 20 ACC provider types, and reaching the highest point in the entire recorded time series.
Early-career osteopaths are significantly more dependent on ACC
Survey data showed that approximately 57% of the average practitioner's clients were ACC funded. For practitioners with less than five years of experience, that reliance was substantially higher. This has direct implications for what would happen to new graduates and early-career practitioners in the event of any funding change.
Patients who see osteopaths tend to stay
Earlier ACC data indicated that osteopaths had the lowest rate of what ACC termed "client promiscuity" - meaning patients who begin osteopathic treatment are less likely to switch to another provider type than patients of any other profession. The research team intends to revisit this metric with current data. It represents a meaningful signal of patient satisfaction and clinical trust.
ACC expenditure on osteopathy is rising
Across the profession, ACC costs have been increasing at an average of approximately 11% per year - significantly faster than the 2-3% annual growth in accident numbers. Understanding what is driving that gap is one of the central questions the research will answer.
People are remaining in the ACC system longer
The ratio of new claims to active claims is declining - meaning a growing proportion of currently funded patients were first injured in a previous year. This raises important questions about chronic injury management and the role osteopathy plays in longer-term recovery journeys.
Before the large dataset analysis, the research collaboration has already produced two peer-reviewed published studies that are being used to set the context for the larger project.
Study 1: Profiling osteopathy in New Zealand
Kovanur Sampath K, Berg N, Paine JL, Orrock P, and Standen C (2025). Profiling osteopathy in New Zealand: Insights into practitioner engagement with Accident Compensation Corporation (ACC) and musculoskeletal (MSK) care. International Journal of Osteopathic Medicine. Advance online publication. doi: 10.1016/j.ijosm.2025.100788
This study provides the first detailed profile of how osteopaths in New Zealand engage with ACC and the musculoskeletal care system. It establishes foundational context for the larger economic analysis - mapping who osteopaths are treating, under what conditions, and how that sits within the broader ACC claims landscape.
Study 2: Trends in thoracic spine injury rates in New Zealand
Kovanur Sampath K and Nitschke T (2025). Trends in thoracic spine injury rates in New Zealand: an eleven-year (2013-2023) analysis of ACC claims. New Zealand Medical Journal. October 2025.
This study examines national trends in thoracic spine injury-related ACC claims over an eleven-year period - directly relevant to the current dataset analysis, which is focused on lumbar and thoracic spine conditions.
In early 2025, Dr Kesh Sampath and Professor Nathan Berg presented the context and early findings of this research programme to ONZ members in a recorded webinar. The presentation covers the history of osteopathy and ACC, the national survey findings, the aggregate ACC data analysis, and the direction of the research programme going forward.
This is recommended viewing for any member who wants to understand the full picture of where this research sits and what it is designed to achieve.
Learning Objectives
After reviewing this webinar, practitioners should be able to:
A full written summary of the webinar content is also available for members who prefer to read rather than watch.
ONZ and the research committee has been actively using the existence and direction of this research in its advocacy work.
In the MBIE Cost of Treatment Regulations submission
ONZ's submission to MBIE on the Cost of Treatment Regulations fee review explicitly noted that the osteopathy-specific ACC dataset analysis is currently underway. The submission requested that decisions on CoTR settings for osteopathy not be treated as final until the forthcoming evidence from this analysis has been considered. This positions the profession to revisit the outcome of that process once the data is available.
The broader market review - what comes next
The ONZ Board has formally endorsed Dr Sampath's proposal to begin scoping a comprehensive osteopathy-specific market review in 2026 - comparable in scope and intent to the Physiotherapy Market Review. This would cover:
This is the logical next step once the ACC dataset analysis is complete - moving from claims data to a full picture of the profession's economic and workforce position within the New Zealand health system.
This research is being conducted on behalf of the entire profession. Here is why it matters for your practice directly:
ACC funding conversations The economic data from this project will strengthen ONZ's position in every future negotiation with ACC about treatment rates, funding thresholds, and the profession's role in musculoskeletal care. We will no longer be making the case without evidence.
Your professional credibility Being able to point to New Zealand-specific economic evidence positions osteopathy alongside physiotherapy and other professions that have already made this case to funders. It changes the nature of the conversation.
Your patient conversations Understanding where osteopathy sits in patient journeys, and what outcomes the data shows, gives you evidence to draw on in clinical practice - and in conversations with GPs, specialists, and other referrers.
The CoTR outcome ONZ has explicitly flagged this research in our MBIE submission. The stronger the evidence, the stronger the case for a fee outcome that reflects the true cost of delivering osteopathic care in New Zealand.
Professor Nathan Berg framed the stakes clearly at the webinar.
More than half of the average New Zealand osteopath's revenue comes from ACC. That is both a strength - ACC funding has driven the profession's growth and accessibility over forty years - and a significant concentration risk. If policy changes, the profession is exposed.
The overarching purpose of this research programme is to build the evidence base that reduces that risk: by strengthening the case for continued and expanded ACC funding, by opening the door to Ministry of Health and public health system funding, and by giving the profession the data it needs to advocate for itself from a position of confidence.
As Nathan put it: we know osteopathy works. Now we need to prove it in the language that funders and policymakers require.
The full analysis is complex and will take time to complete. ONZ will share updates with members as the work progresses throughout 2026 and beyond.
If you have questions about this project, data you think may be relevant, or an interest in contributing to the research programme, contact the research team directly.
Contact Dr Kesh Sampath, Chair ORC-NZ: research@osteopathsnz.co.nz
Representing Osteopaths in
Aotearoa, New Zealand
Tel 09 419 0450
Email info@osteopathsnz.co.nz
Address PO Box 65503
Browns Bay
Auckland 0754, New Zealand
