Chiropractic Consumer Confidence, Part One

 By Dr Michael Perusich

Election Anxiety Is Real. And It May Be Quietly Undermining Your Chiropractic Practice Growth.

When consumer confidence declines, patients don't necessarily stop needing chiropractic care. They start questioning whether they can afford it.

There is something happening in the chiropractic marketplace that actually may have very little to do with chiropractic itself.

Consumers are becoming increasingly cautious about spending money. And the upcoming midterm elections are adding another layer of uncertainty to an already nervous economy.

Political advertising, conflicting economic predictions, inflation concerns, interest rates, healthcare policy debates, and nonstop negative media coverage can create an environment in which consumers become hesitant to make financial commitments.

And when consumers become hesitant, their purchasing behavior changes.

The latest economic indicators reinforce that concern. The Conference Board reported that consumer confidence declined to 81.9 in September 2026, while its Expectations Index fell to 63.6.¹ Preliminary October findings from the University of Michigan showed consumer sentiment falling to 46.3, reflecting continued concerns about household finances and the economy.²

While these surveys do not necessarily establish that the election itself is responsible for declining confidence, they do demonstrate the financial uncertainty surrounding consumers as the election approaches.

Here’s the reality…Your patients are not immune to this psychology. And neither is your practice.

The Real Threat Right Now Is Consumer Hesitation.

When people become uncertain about their financial future, they begin protecting their money.

They postpone purchases. They scrutinize subscriptions. They delay commitments. They become more selective about where their discretionary dollars go.

Federal Reserve research recognizes this tendency: economic uncertainty can encourage households to delay spending and preserve financial resources until conditions become more clear.³

And unfortunately, many consumers still place chiropractic care in that discretionary spending category, particularly when they are no longer experiencing significant symptoms.

Think about what happens inside your clinic.

A patient who previously scheduled twice a month suddenly wants to come once a month.

Another patient decides to discontinue maintenance care.

A new patient appreciates your recommendations but wants to "think about it."

Someone who has been coming for years suddenly asks whether they really need to continue.

These aren't always objections to chiropractic. They may be expressions of financial uncertainty.

The danger is assuming that every slowdown is a marketing problem when, in reality, you may be experiencing a consumer-confidence problem.

Your Wellness Patients May Be the First to Reconsider Care.

Here's something chiropractors need to think seriously about.

Patients experiencing significant pain or physical limitations have an immediate reason to seek treatment.

But what about your wellness patients?

These individuals may feel perfectly fine. They're not necessarily responding to pain, disability, or an urgent physical concern.

When household finances tighten, they may begin questioning whether ongoing chiropractic care deserves a place in their budget.

If the only value your patient understands is feeling better, don't be surprised when they stop coming after they feel better.

That's why patient education, regular chiropractic checkups, and solid maintenance care are so important.  So is the idea that PRN never enters our patient conversations, because everyone deserves our recommendations for continued care.  

The goal isn't to manufacture a reason for continued treatment. It's to maintain meaningful patient relationships, communicate the purpose of clinically appropriate care, and help patients understand the choices available to them.

Patients shouldn't have to rediscover your practice every time they experience a problem.  They should already understand the value you bring to them.  And if they don’t, therein lies an opportunity to get better at your communication. 

Stop Selling Visits. Start Demonstrating Value.

Here is where chiropractic practices can make a critical mistake.

When patient visits begin slipping, doctors frequently respond by offering discounts, buying more advertising, or chasing additional new patients.

But bringing more people into a practice with declining retention is like pouring water into a leaking bucket.

You don't necessarily need more patients. You need your existing patients to have more compelling reasons to stay.

Patients who see chiropractic as an occasional expense may be more likely to reconsider it when their budgets tighten.

Patients who understand how appropriate chiropractic care supports their personal health goals may be better prepared to prioritize it.

That distinction is created through education, engagement, clinical relevance, financial transparency, and the experience your practice delivers.

Patients don't simply evaluate what you charge. They evaluate what they believe they're receiving in return.

Seven Strategies to Combat Consumer Anxiety

1. Make chiropractic care a meaningful healthcare priority.

Stop assuming that patients automatically recognize the value of what you provide. Communicate clinical progress, explain treatment objectives, and help patients understand how your recommendations relate to their personal goals.  If you aren’t understanding what the patient’s personal goals are, you likely are creating a situation whereby they can’t engage with your recommendations.  

2. Eliminate financial surprises.

Economic uncertainty can make unpredictable healthcare expenses harder to justify. Transparent cash fees, clearly defined insurance benefits, strategic membership options, and straightforward financial agreements build confidence. But don’t overlook the message your insurance EOB sends. The fees patients see can dramatically shape their perception of what your care actually costs, and whether they believe they can afford to continue once insurance stops paying.

3. Strengthen Advanced Multiple Scheduling.

Patients who leave without their next clinically recommended appointment scheduled must make another purchasing decision later. Help patients plan their appropriate care in advance while respecting their preferences and clinical needs.

4. Reactivate your inactive patient database.

Don't assume inactive patients no longer value chiropractic. Reach out with meaningful opportunities to reconnect, including annual checkups, appropriate progress evaluations, or discussions about new concerns.

5. Stop using discounts as your first response.

A patient questioning affordability isn't necessarily asking for a cheaper adjustment. They may need greater financial clarity, an explanation of value, or a conversation about clinically appropriate care alternatives.

6. Turn your staff into patient-engagement partners.

Train chiropractic assistants to recognize changes in patient behavior, identify financial concerns, and communicate with empathy. Cancellations, declining future scheduling, and increasing payment questions deserve attention before patients quietly disappear.

7. Pay attention to your numbers.

At Kats Consultants, we continually emphasize the importance of the deep statistical numbers in your practice beyond patient visits, new patients, and collections.  But don't simply watch the numbers. Investigate the behaviors driving them, and the trends they are creating.

Are wellness patients disengaging? Are patients completing fewer recommended visits? Is your case acceptance weakening? Are collections declining despite steady new-patient volume?  Are the trends revealing deep problems that need to be corrected?

The scoreboard doesn't solve problems. It tells you where to start looking.

Your Fee Strategy May Be Making Consumer Anxiety Worse.

Here's another uncomfortable possibility.

Your patients may already be financially apprehensive, and your own billing procedures could be increasing that anxiety.

Confusing insurance explanations, unpredictable patient balances, and cash fees that appear disconnected from previous insurance payments can make patients hesitant to continue care.

Think about the patient receiving an Explanation of Benefits showing a $165 chiropractic charge.

When insurance stops paying, that patient may assume continuing care means paying $165 out of pocket for every visit.

If you haven't clearly communicated your actual financial options, your own billing system may be helping convince the patient that ongoing care is unaffordable.

Your fee strategy should build financial confidence, not create financial confusion.

That's why deliberate pricing, billing transparency, and strategically structured cash-care options, and membership-based plans (such as ChiroHealth USA) have become essential practice-management considerations.

Here's the Reality Doctors Need to Recognize.

Election anxiety doesn't automatically disappear on Election Day.

Regardless of the election results, consumers may continue worrying about inflation, employment, interest rates, healthcare expenses, and their financial future.

And those concerns can influence how they prioritize chiropractic care.

But let's not use the election as an excuse for every disappointing practice statistic.

A weak retention system was weak before the election.

An ineffective fee strategy was ineffective before the election.

Poor patient engagement didn't suddenly begin when political advertising increased.

A strong economy can hide a poorly managed practice. An uncertain economy exposes it.

The Bottom Line: Don't Let Consumer Fear Become Your Business Strategy.

You cannot control election results.  Nor can you control inflation, interest rates, or the daily economic headlines.

But you can control your patient experience, retention systems, communication tactics, fee strategy, and the financial discipline of your practice.

The practices that successfully navigate economic uncertainty won't necessarily be the busiest. They'll be the ones that maintain strong patient relationships, demonstrate appropriate clinical value, and operate with greater financial efficiency.

At Kats Consultants, we believe doctors must stop depending on yesterday's practice-management strategies to address tomorrow's business challenges.

You don't control consumer confidence. But you have considerable influence over how much confidence consumers have in your practice.

And that brings us to an even more important question.

What happens when economic uncertainty exposes weaknesses in your business model?

In Part 2, we'll examine why some practices are better positioned to navigate economic uncertainty—and how to build a chiropractic business that doesn't require a perfect economy to succeed.

Dr. Michael Perusich
CEO | Kats Consultants, LLC

www.katsconsultants.com

References

1. The Conference Board. (September 29, 2026). US Consumer Confidence Fell in September. Consumer Confidence Survey. September Consumer Confidence Index: 81.9; Expectations Index: 63.6.
2. University of Michigan, Surveys of Consumers. (October 9, 2026). Preliminary Results for October 2026. Preliminary Index of Consumer Sentiment: 46.3.
3. Board of Governors of the Federal Reserve System. (April 24, 2025). Costs of Rising Uncertainty. FEDS Notes. Examines the relationships among economic uncertainty, consumer spending, investment, and credit conditions.

Editorial note: The cited research establishes consumer-confidence trends and general responses to uncertainty. The specific implications for chiropractic practice performance are Kats Consultants' strategic interpretation rather than directly measured effects in those studies. The information contained herein is for education purposes only.  Consult with a professional about your practice specifics and how this information may be impacting your business.