One reason for the estimate may be that it is difficult to determine how much money is spent on unreported or unlicensed massage, so the actual expenditures may be higher than stated. Another problem with the numbers is that some massage expenses are covered by health insurance, and not represented in the out-of-pocket estimates. Other forms of event-related and amenity massage are not even on the radar.
The most recent surveys by NCCAM indicate that Americans currently spend close to $3 trillion on healthcare annually. Of that amount, nearly 1.5% is spent out-of-pocket on Complimentary Alternative Medicine (CAM). Of this estimated $40 billion plus, roughly 33% is paid to CAM practitioners. Massage as reported, must share this slice of the market with supplements, yoga, and other alt-med approaches, some of which have yet to be recognized and counted.
Nearly half of conventional healthcare patients report using CAM, and most healthcare workers report using it, but since the majority of CAM expenditures are self-administered, and not discussed with physicians or insurers, it is difficult to estimate the exact amount spent in total on each therapy.