Coverage for Obesity Prevention and Treatment Services: Analysis of Medicaid and State Employee Health Insurance Programs
Coverage for Obesity Prevention and Treatment Services: Analysis of Medicaid and State Employee Health Insurance Programs
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DOI：
10.1002/oby.22307
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发表时间：
2018-12-01
期刊：
影响因子：
6.9
通讯作者：
Dietz, William
中科院分区：
文献类型：
--
作者：
Jannah, Nichole;Hild, Jeff;Dietz, William
目的本研究调查了2009至2017年间医疗补助计划和国家雇员医疗保险计划中成人肥胖治疗服务覆盖面的变化。方法对所有50个州和哥伦比亚特区的医疗补助计划和州雇员健康保险计划的行政材料进行审查，以确定针对成年人(21岁)的循证治疗方式的覆盖范围和支付政策，包括营养咨询、药物治疗和减肥手术。结果从2009年到2017年，营养咨询的州雇员计划覆盖比例增加了75%(从24个州增加到42个州)，药物治疗的州雇员计划比例增加了75%(从14个州增加到23个州)，减肥手术的覆盖率增加了23%(从35个州增加到43个州)。医疗补助计划的比例表明，营养咨询的覆盖率增加了133%(从9个州增加到21个州)，减肥手术的覆盖率增加了9%(从45个州增加到49个州)，药物治疗的覆盖率没有净增加(两个计划年都有16个州)。结论自2009年以来，医疗补助和州雇员保险计划对成人肥胖护理的覆盖范围有了很大改善。然而，在许多州，推荐的治疗方式仍然没有涵盖。在覆盖范围扩大的地方，对提供者和受益者进行关于提供和正确使用循证肥胖治疗的教育可能会改善健康结果。
Objective This study examined changes in coverage for adult obesity treatment services in Medicaid and state employee health insurance programs between 2009 and 2017. Methods Administrative materials from Medicaid and state employee health insurance programs in all 50 states and the District of Columbia were reviewed for indications of coverage and payment policies specific to evidence-based treatment modalities for adults (>= 21 years of age) with obesity, including nutritional counseling, pharmacotherapy, and bariatric surgery. Results From 2009 to 2017, the proportion of state employee programs indicating coverage increased by 75% for nutritional counseling (from 24 to 42 states), 64% for pharmacotherapy (from 14 to 23 states), and 23% for bariatric surgery (from 35 to 43 states). The proportion of Medicaid programs indicating coverage increased by 133% for nutritional counseling (from 9 to 21 states) and 9% for bariatric surgery (from 45 to 49 states), with no net increase for pharmacotherapy (16 states in both plan years). Conclusions Coverage for adult obesity care improved substantially in Medicaid and state employee insurance programs since 2009. However, recommended treatment modalities are still not covered in many states. Where coverage has expanded, educating providers and beneficiaries on the availability and proper use of evidence-based obesity treatments may improve health outcomes.