To pay or not to pay: Public perception regarding insurance coverage of obesity treatment

Authors

  • Susan J. Woolford,

    Corresponding author
    1. The Child Health Evaluation and Research (CHEAR) Unit, Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
    2. Division of General Pediatrics, Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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    • Author contributions: S. J. Woolford assisted with conception and design, acquisition of data, analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. A. Butchart assisted with analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. S. J. Clark and A. Fagerlin assisted with design, acquisition of data, analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. M. M. Davis and J. D. Geiger assisted with analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article.

  • Sarah J. Clark,

    1. The Child Health Evaluation and Research (CHEAR) Unit, Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
    2. Division of General Pediatrics, Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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    • Author contributions: S. J. Woolford assisted with conception and design, acquisition of data, analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. A. Butchart assisted with analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. S. J. Clark and A. Fagerlin assisted with design, acquisition of data, analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. M. M. Davis and J. D. Geiger assisted with analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article.

  • Amy Butchart,

    1. The Child Health Evaluation and Research (CHEAR) Unit, Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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    • Author contributions: S. J. Woolford assisted with conception and design, acquisition of data, analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. A. Butchart assisted with analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. S. J. Clark and A. Fagerlin assisted with design, acquisition of data, analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. M. M. Davis and J. D. Geiger assisted with analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article.

  • James D. Geiger,

    1. Section of Pediatric Surgery, Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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    • Author contributions: S. J. Woolford assisted with conception and design, acquisition of data, analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. A. Butchart assisted with analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. S. J. Clark and A. Fagerlin assisted with design, acquisition of data, analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. M. M. Davis and J. D. Geiger assisted with analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article.

  • Matthew M. Davis,

    1. The Child Health Evaluation and Research (CHEAR) Unit, Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
    2. Division of General Pediatrics, Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
    3. Section of Pediatric Surgery, Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
    4. Division of Internal Medicine, Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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    • Author contributions: S. J. Woolford assisted with conception and design, acquisition of data, analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. A. Butchart assisted with analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. S. J. Clark and A. Fagerlin assisted with design, acquisition of data, analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. M. M. Davis and J. D. Geiger assisted with analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article.

  • Angela Fagerlin

    1. Division of Internal Medicine, Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
    2. Gerald R. Ford School of Public Policy, Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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    • Author contributions: S. J. Woolford assisted with conception and design, acquisition of data, analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. A. Butchart assisted with analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. S. J. Clark and A. Fagerlin assisted with design, acquisition of data, analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article. M. M. Davis and J. D. Geiger assisted with analysis and interpretation of data, drafting and critical revision of the article, and final approval of the article.


  • Disclosure: The authors declare no conflict of interest.

    Funding agencies: Study supported by the Department of Pediatrics, University of Michigan.

Abstract

Objective

To explore public opinion regarding insurance coverage for obesity treatment among severely obese adolescents.

Design and Methods

The National Poll on Children's Health was fielded to a nationally representative sample of US adults, January 2011. Respondents (n = 2150) indicated whether insurance should cover specific weight management services for obese adolescents and whether private insurance and Medicaid should cover bariatric surgery. Sampling weights were applied to generate nationally representative results. Linear and logistic regression analyses were performed to assess associations.

Results

More respondents endorsed insurance coverage for traditional healthcare services (mental health 86%, dietitian 84%) than for services generally viewed as outside the healthcare arena (exercise programs 65%, group programs 60%). For bariatric surgery, 81% endorsed private insurance coverage; 55% endorsed Medicaid coverage. Medicaid enrollees, black, Hispanic, and low-income respondents had greater odds (P < 0.05) of endorsing bariatric surgery coverage by Medicaid, compared to the referent groups (non-Hispanic white, income ≥$60K, private insurance).

Conclusion

Although public support for insurance coverage of traditional weight management services appears high, support for Medicaid coverage for bariatric surgery is lower and varies by demographics. If public opinion is a harbinger of future coverage, low-income adolescents could experience disparities in access to treatments like bariatric surgery.

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