title: Paying for obesity: a changing landscape.
abstract: BACKGROUND
  Coverage for obesity related services is highly variable. Despite this, health plans, purchasers, and states have mounted numerous recent initiatives.
  
  
  OBJECTIVE
  To identify the range of approaches being used to address coverage and reimbursement for childhood obesity services.
  
  
  METHODS
  Key informant interviews were conducted using a semi-structured protocol to identify the types of activities they or their organization were engaged in to address childhood obesity, to learn about private payer policies and procedures, to identify best practices, potential resources and/or other key informants. Domains addressed in the protocol included scope of the respondent's organization's activities, the rationale for supporting obesity activities, the degree to which obesity services were a covered benefit and what if any barriers or challenges were encountered in implementation, the policy climate within which the organization operates (e.g. state legislation, initiatives or task forces), and any assessment of the impact and/or cost of implementing their initiatives. The individuals interviewed represented respondents from each of the following categories: employer, health plan, and state insurance programs and conducted by phone between November 2007 and March 2008. In addition to the information gathered by the key informant interviews we conducted a search of the relevant peer review and grey literature between 2005 and 2008 and input from a national expert advisory group.
  
  
  RESULTS
  Significant variation, as well as recent changes, were identified in both the private and public sector. Approaches included new benefits and incentives for parents and providers. Only anecdotal evidence of impact of the recent changes was available.
  
  
  CONCLUSIONS
  There is important forward movement in how public and private players are addressing paying for obesity related services. Medicaid and SCHIP programs have an opportunity to provide additional leadership. Substantial investments in evaluation and research are needed to learn which approaches are most effective.
authors.affiliation: Child Policy Research Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7014, Cincinnati, OH 45229, USA. lisa.simpson@cchmc.org
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Simpson
authors.forename: Julie
authors.initials: J
authors.lastname: Cooper
mesh_terms: D002648:Child; D002662:Child Health Services / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005544:Forecasting; D006266:Health Education / Q000191:economics; D006291:Health Policy; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000639:trends*; D008297:Male; D009765:Obesity / Q000191:economics* / Q000517:prevention & control* / Q000628:therapy; D011050:Policy Making; D017149:Private Sector / Q000191:economics; D017150:Public Sector / Q000191:economics; D014481:United States