Effects of outcome-driven insurance reimbursement on short-term weight control

• Published in: International Journal of Obesity Vol. 27; no. 11; pp. 1423 - 1429
• Main Authors: Hubbert, K.A, Bussey, B.F, Allison, D.B, Beasley, T.M, Henson, C.S, Heimburger, D.C
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.11.2003; Nature Publishing
• Subjects: Adult; Aged; Alabama; Ambulatory care; Anthropometry; Arthritis; Biological and medical sciences; body mass index; Body weight; Cardiovascular disease; Costs; Diabetes; Female; Follow-Up Studies; Gallbladder; Gallbladder diseases; gender; Humans; Hypertension; Incentive plans; insurance; Lifestyles; Logistic Models; Male; Medical sciences; Metabolic diseases; Middle Aged; Motivation; nationalities and ethnic groups; Nutrition research; Obesity; Obesity - psychology; Obesity - therapy; Osteoarthritis; Patient Acceptance of Health Care; patients; Prospective Studies; regression analysis; Reimbursement; Reimbursement, Incentive; Research centers; therapeutics; Treatment Outcome; Weight control; Weight Loss; Alabama; United States > US; Short term; Obesity; Prognosis; Treatment; Incentives; Nutrition disorder; Reimbursement; Nutritional status; Weight; Obesity treatment outcomes
• ISSN: 0307-0565; 1476-5497
• DOI: 10.1038/sj.ijo.0802403

CONTEXT: Although most health insurers exclude coverage of weight control therapy, one local insurer offered partial reimbursement of the cost of a weight control program, using an incentive plan. OBJECTIVE: To determine whether outcome-driven insurer-based reimbursement improves participation in a weight control program and short-term weight loss outcomes. DESIGN: Cohort follow-up study between January 1998 and February 2001. SETTING: Community weight management program operated by an academic medical center. SUBJECTS: Obese participants who had the potential for reimbursement (Group A, n=25) and participants in the same program classes (Group B, n=100) who had no possibility for reimbursement. Subjects in Group B were selected from among 206 potential participants using a propensity score to match them with subjects in Group A on age, gender, ethnicity, starting BMI, starting weight, and educational, economic, and demographic variables. INTERVENTION: Group lifestyle-based weight management program. The insurer reimbursed half the cost of the program to obese participants who met minimum weight criteria, paid the program fee at enrollment, attended >=10 of the 12 classes, and lost >=6% of initial body weight after 12 weeks. MAIN OUTCOME MEASURES: Participation rates and weight loss outcomes. RESULTS: Group A subjects attended significantly more classes (mean±s.d.: 10.1±1.8 vs 8.2±2.5, P<0.001) and lost more weight than Group B subjects (6.1±3.1 vs 3.7±3.6%, P=0.002). While 84% of Group A subjects attended >=10 classes, only 37% of Group B subjects did so (P<0.001); 56% of Group A subjects lost >=6% of body weight, but only 20% of Group B subjects did so (P<0.001); 56% of Group A subjects achieved both the class attendance and weight loss goals, but only 14% of Group B subjects did so (P<0.001). Logistic regression estimated that Group A subjects had 8.2 times the odds of attending >=10 classes and 4.5 times the odds of losing >=6% of body weight of Group B subjects, after controlling for class attendance. >CONCLUSIONS: Insurer-based reimbursement that is contingent upon initial financial commitment on the part of the patient, consistent program participation, and successful weight loss is associated with significantly better short-term weight control outcomes.