Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27705, USA.
Prev Chronic Dis. 2013 Apr 4;10:E49. doi: 10.5888/pcd10.120163.
Overweight and obesity are public health issues in the United States, and veterans have a higher rate of overweight and obesity than the general population. Our objective was to examine whether copayment elimination increased use of a weight loss clinic by veterans.
We examined clinic use by 44,411 new patients seen in a Veterans Affairs (VA) MOVE! weight management clinic before the copayment elimination and clinic use by 64,398 new patients seen in the year after copayment elimination. We examined clinic use via mixed-effects models for patients who were already exempt from copayment and patients who were newly exempt from copayment. We used 2 outcomes before and after copayment elimination: 1) the ratio of number of clinic visits by new users with the mean number of MOVE! clinic visits by all users, and 2) the number of clinic visits by each new user in the 6 months after their first visit. All models were adjusted for patient and clinic factors.
Among newly exempt patients, the clinic-standardized rate of new use increased by 2.2% after the copayment was eliminated but increased 12% among already exempt veterans. This finding was confirmed in adjusted analyses. Analysis of number of clinic visits adjusted for patient and clinic factors also found that exempt and nonexempt veterans had similar numbers of repeat clinic visits.
We saw an unexpected larger increase in demand among veterans who receive all VA care for free. These results suggest that VA should not assume that copayment reductions for selective preventive services will motivate patient change and achieve intended system-level outcomes.
超重和肥胖是美国的公共卫生问题，退伍军人的超重和肥胖率高于普通人群。我们的目的是研究共付额取消是否会增加退伍军人使用减肥诊所的频率。
我们研究了在共付额取消之前，44411 名新患者在退伍军人事务部 (VA) MOVE! 体重管理诊所就诊的情况，以及在共付额取消后的一年中，64398 名新患者的就诊情况。我们通过混合效应模型，对已经免除共付额的患者和新免除共付额的患者进行了诊所使用情况的分析。我们使用了共付额取消前后的两个结果：1）新用户就诊次数与所有用户 MOVE! 诊所就诊次数的平均值之比，以及 2）每位新用户在首次就诊后 6 个月内的就诊次数。所有模型都根据患者和诊所因素进行了调整。
在新免除共付额的患者中，取消共付额后，诊所标准化新使用率增加了 2.2%，但已经免除共付额的退伍军人的使用率增加了 12%。这一发现在调整后的分析中得到了证实。对患者和诊所因素进行调整后的诊所就诊次数分析也发现，豁免和非豁免退伍军人的重复就诊次数相似。
我们发现，所有退伍军人都可以免费获得 VA 提供的所有医疗服务，这一群体对需求的增长出人意料地更大。这些结果表明，VA 不应假设选择性预防服务的共付额降低将激励患者改变并实现预期的系统水平结果。
