Insurance reimbursement for the treatment of obesity in children
Insurance reimbursement for the treatment of obesity in children
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DOI：
10.1016/s0022-3476(99)70243-x
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发表时间：
1999-05-01
影响因子：
5.1
通讯作者：
Marx, AL
中科院分区：
文献类型：
--
作者：
Tershakovec, AM;Watson, MH;Marx, AL
目的：虽然肥胖在美国儿童中的流行率正在迅速增加，但第三方付款人对评估和管理的补偿可能有限。这项分析的目的是评估肥胖儿童儿童体重管理计划的第三方支付者报销率，以及儿童特征(如肥胖程度)、保险政策类型和报销率之间的关系。研究设计：在三级保健儿科医疗中心进行横断面调查。结果：从1995年10月17日至1997年12月23日，共有191名儿童参加了儿童医院体重管理计划。这些儿童的平均年龄为10.1+/-0.3岁，平均体重指数z得分为4.9+/-0.2；46%是黑人，65%是女性。报销率的中位数为11%，差异很大(0%到100%)。不同保单类型的报销率差别很大。男孩和女孩或白人和黑人儿童之间的报销率没有差异，报销率也与肥胖程度无关。结论：尽管肥胖儿童需要体重管理服务，但这些低报销率使此类项目在没有外部支持或有相当大比例患者能够自掏腰包的情况下无法长期财务可行性。
Objective: Although the prevalence of obesity among children in the United States is rapidly increasing, third party payer reimbursement for evaluation and management may be limited. The purpose of this analysis is to evaluate third party payer reimbursement rates for a pediatric weight management program for obese children and associations among child characteristics (eg, degree of obesity), Insurance policy type, and reimbursement rates.Study design: Cross-sectional survey in a tertiary care pediatric medical center. Reimbursement rate of charges for initial evaluation and management and patient characteristics were evaluated for children 2 years or older enrolled in the Children's Hospital Weight Management Program.Results: From October 17, 1995, to December 23, 1997, 191 children were evaluated in the Children's Hospital Weight Management Program. The children were on average 10.1 +/- 0.3 years old, with a mean body mass index z-score of 4.9 +/- 0.2; 46% were black, and 65% were female. The median reimbursement rate was 11% and varied widely (0% to 100%). Reimbursement rates differed significantly among policy types. Reimbursement rates did not differ between boys and girls or white and black children, nor were reimbursement rates associated with the degree of obesity.Conclusions: Despite the need for weight management services for obese children, these low reimbursement rates preclude the long-term financial viability of such programs without external support or a significant proportion of patients who can pay "out-of-pocket."