Costs Often Limit Access to Counseling

(February 4, 2010) - Cost may be one of the reasons more people don't take advantage of programs that can help people lose weight and quit smoking. (Read about "Losing Weight" "Quit Smoking") In a study published in the American Journal of Preventive Medicine, researchers found that when primary care clinicians and community counselors collaborated to offer free counseling services to patients, there was an overwhelming positive response. Yet, when the same services were offered at a cost to the patient, there was a significant drop in participation.

Reducing obesity (Read about "Obesity") and smoking have become national priorities in the United States. Research has shown that intensive counseling can positively impact each problem. However, such counseling is typically not covered by medical insurance.

Patients confirmed that costs introduced a barrier to counseling. Some patients were explicit that charges would prevent participation while others who had deferred counseling in the past were motivated to enroll because it was free. Clinicians reported that removing cost as an impediment, combined with an easy means to refer patients, allowed patient discussions to focus on behavior change. The heightened patient interest reversed when charges were reinstituted. Fewer successes also diminished motivation for the counselors.

Alex H. Krist MD, MPH, one of the researcher says, "Not just patients, are influenced by costs. Despite prompts, nurses were less likely to record patients' BMI (Read about "Body Mass Index") and smoking status during the no-coverage period. Clinicians were also less likely to discuss health behaviors with patients. However, even when clinicians did offer a referral, 81 percent fewer patients accepted."