With a progressively rising prevalence of obesity, U.S. society is faced with the prospect of very high future costs to treat its complications, especially diabetes, hypertension, and CHD. Because medical treatment for these conditions is increasingly effective, their societal impact will likely be mediated more through morbidity and high costs than through mortality. Many obese persons do not seek professional help in managing their obesity, and many primary care practitioners feel inadequate to treat it. For both parties, inadequate reimbursement for the costs of obesity treatment is a significant barrier. Although most health insurers do not cover obesity treatment and prevention, they will be under increasing pressure to do so. Because the costs of medications to treat obesity-related conditions have increased substantially in recent years, significant cost savings could potentially be realized when weight reduction enables medication dosages to be decreased or discontinued. We wish to examine whether incentive-based reimbursements for the costs for professional weight control services will make those services more accessible and attractive to obese individuals while not exposing the reimburser to unreasonable financial risk. We propose a pilot prospective study to determine whether a reimbursement incentive (the prospect of reimbursement of half of the out-of-pocket fee for participation in the UAB EatRight Weight Management Program, when it is contingent upon consistent Program participation and loss of >=6% of initial body weight) is associated with (1) a higher rate of Program enrollment and (2) greater percent weight loss, greater reductions in medication dosages and costs, and fewer visits to health care providers after 12 weeks and 9 months. We will also determine (3) what proportion of obese subjects actually qualifies for reimbursement. We will use a sequential control-intervention-control design with transition periods between phases to reduce residual effects from changing reimbursement options. Although the study will focus on initial Program enrollment and short-term outcomes, its results will form the foundation of R01 studies examining reimbursement incentives for long-term weight control and health disparities issues, e.g., differential response rates between African Americans and Caucasians or among persons from different socioeconomic levels. If effective, our results will suggest a way to improve the delivery of obesity treatment and provide evidence for making reimbursement incentives part of a national strategy for curbing the obesity epidemic.
NIH ExPorter
NIH ExPorter