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

International Journal of Obesity volume 27, pages 1423–1429 (2003)Cite this article

Abstract

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.

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Acknowledgements

We appreciate the assistance of Beth A Baker, MS with some of the early statistical analyses. This work was supported in part by the UAB Clinical Nutrition Research Center, NIH Grant # P30 DK 56336.

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Authors and Affiliations

  1. Department of Nutrition Sciences, Clinical Nutrition Research Center, University of Alabama at Birmingham, Birmingham, AL, USA

    K A Hubbert, B F Bussey, D B Allison, C S Henson & D C Heimburger

  2. Department of Biostatistics, Clinical Nutrition Research Center, University of Alabama at Birmingham, Birmingham, AL, USA

    D B Allison & T M Beasley

  3. Department of Medicine, Clinical Nutrition Research Center, University of Alabama at Birmingham, Birmingham, AL, USA

    D C Heimburger

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  1. K A Hubbert
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  2. B F Bussey
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Correspondence to D C Heimburger.

Appendix

Appendix

Table A1 provides HMO reimbursement plan height/weight eligibility criteria Table A1

Table a1 HMO reimbursement plan height/weight eligibility criteriaa
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Hubbert, K., Bussey, B., Allison, D. et al. Effects of outcome-driven insurance reimbursement on short-term weight control. Int J Obes 27, 1423–1429 (2003). https://doi.org/10.1038/sj.ijo.0802403

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