INTRODUCTION Recent studies suggest that both chiropractors and physicians provide effective care for back pain, but the relative costs of chiropractic and physician care are still debated (USDHHS, 1994). Manga et al. (1993) argue that chiropractors are less costly than physicians. Carey et al. (1995) use data on charges to conclude that primary care physicians are the least-cost providers. The relative costs of health care are not, however, the appropriate comparison for work-related back pain. Workers' compensation insurers and self-insured employers pay health-care costs and disability benefits for persons with work-related injuries. From the payers' viewpoint, relatively costly modes of health care are efficient if the care produces sufficiently large savings in indemnity benefits by reducing durations of work absences. The authors use data from a workers' compensation insurer (the Zenith Insurance Co.) to compare the sum of health care and indemnity costs for non-surgical back patients treated by chiropractors or physicians. The data refer to approximately 850 closed claims for episodes of back pain that began and ended between 1991 and 1993. The comparison groups are (1) cases treated by a physician but not by a chiropractor and (2) cases treated by a chiropractor but not by a physician. The authors' measures of health-care costs are payments to providers, rather than health-care charges. Charges are deceptive because payment discounts vary among providers. The authors compare chiropractors' and physicians' pricing, service mix, and service utilization, and describe how each contributes to the differences between the average health-care costs of claimants treated by chiropractors and physicians. The measures of outcomes are the distribution of injured workers among claim types (medical only, temporary disability only, and permanent partial disability) and the durations of temporary disability claims. The authors estimate an ordered logit model to determine the relative effect of chiropractic treatment on the distribution of claim types, controlling for differences between the characteristics of chiropractic and physician patients. The authors estimate a Weibull duration model to determine the relative effect of chiropractic treatment on durations of work absence within the temporary and permanent disability groups. One limitation of the study is that severity of injury is unobserved. The problem of unobserved differences between chiropractor and physician patients is addressed by estimating a second set of models in which support points are added to control for the effects of unobserved worker heterogeneity. To the authors' knowledge, this is the first application of the method to the problem of unobserved differences that can include the severity of health conditions. The cost data are unusual because they include both payments for health care and disability benefit payments. The results show that the average total costs of back claims treated by chiropractors are lower than the average total costs of back claims treated by physicians. Part of the cost differential reflects the fact that a relatively large proportion of chiropractic patients are not paid disability benefits because they return to work within California's three-day waiting period. This result is similar to Ebrall's (1992) findings for Australian workers. The apparent superiority of chiropractic care disappears, however, when the probability of returning to work in less than four days is estimated from multivariate models that control for unobserved heterogeneity in the characteristics of individual workers. These results show no significant differences in the effectiveness of chiropractic and physician care in determining the probability of returning to work within the waiting period. The estimates of the effects of care on durations of work absence for temporary and permanent disability claims do, however, weakly support the conclusion that chiropractors are more effective than physicians in reducing durations of work absence. …