MMWR Morb Mortal Wkly Rep. 2003 May 30;52(21):496-500.
Tobacco use is the leading preventable cause of death in the United States. One of the national health objectives for 2010 is to increase insurance coverage of evidence-based treatment for nicotine dependence (i.e., total coverage of behavioral therapies and Food and Drug Administration [FDA]--approved pharmacotherapies) in Medicaid programs from 36 states to all states and the District of Columbia (DC) (objective 27.8). To increase both the use of treatment by smokers attempting to quit and the number of smokers who quit successfully, the Guide to Community Preventive Services recommends reducing the "out-of-pocket" cost of effective tobacco-dependence treatments (i.e., individual, group, and telephone counseling, and FDA--approved pharmacotherapies) for smokers. The 2000 Public Health Service (PHS) Clinical Practice Guideline supports expanded insurance coverage for tobacco-dependence treatments. In 2000, approximately 32 million low-income persons in the United States received their health insurance coverage through the federal-state Medicaid program; 11.5 million (36%) of these persons smoked (CDC, unpublished data, 2000). The amount and type of coverage for tobacco-dependence treatment offered by Medicaid has been reported for 1998 and 2000 from state surveys conducted by the Center for Health and Public Policy Studies (CHPPS) at the University of California, Berkeley. All states and DC were re-surveyed in 2001 about amount and type of coverage, and level of coverage since 1994. This report summarizes the results of the survey, which indicate that the number of Medicaid programs providing some coverage for tobacco-dependence counseling or medication increased from 34 in 2000 to 36 in 2001, but only one state offered coverage for all the counseling and pharmacotherapy treatments recommended by the 2000 PHS guideline. If the 2010 national health objective is to be achieved, Medicaid coverage for treatment of tobacco dependence should be increased dramatically.
在美国，吸烟是可预防的首要死因。2010年的一项国家卫生目标是，将医疗补助计划中基于证据的尼古丁依赖治疗（即行为疗法和美国食品药品监督管理局[FDA]批准的药物疗法的全面覆盖）的保险覆盖范围，从36个州扩大到所有州及哥伦比亚特区（DC）（目标27.8）。为了增加试图戒烟的吸烟者对治疗的使用以及成功戒烟的吸烟者数量，《社区预防服务指南》建议降低吸烟者有效戒烟治疗（即个体、团体和电话咨询以及FDA批准的药物疗法）的“自付费用”。2000年美国公共卫生服务（PHS）临床实践指南支持扩大对戒烟治疗的保险覆盖范围。2000年，美国约有3200万低收入人群通过联邦-州医疗补助计划获得医疗保险；其中1150万（36%）的人吸烟（疾病控制和预防中心，未发表数据，2000年）。加利福尼亚大学伯克利分校健康与公共政策研究中心（CHPPS）进行的州调查，报告了1998年和2000年医疗补助计划提供的戒烟治疗的覆盖范围和类型。2001年，对所有州和哥伦比亚特区重新进行了关于覆盖范围和类型以及自1994年以来的覆盖水平的调查。本报告总结了调查结果，结果表明，提供某种戒烟咨询或药物治疗覆盖的医疗补助计划数量从2000年的34个增加到2001年的36个，但只有一个州提供了2000年PHS指南推荐的所有咨询和药物治疗。如果要实现2010年的国家卫生目标，医疗补助计划对戒烟治疗的覆盖范围应大幅增加。
