title: Demand for weight loss counseling after copayment elimination.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27705, USA. mlm34@duke.edu
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
authors.forename: William S
authors.initials: WS
authors.lastname: Yancy
authors.forename: Maren
authors.initials: M
authors.lastname: Olsen
authors.forename: Hollis J
authors.initials: HJ
authors.lastname: Weidenbacher
authors.forename: David
authors.initials: D
authors.lastname: Abbott
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: Santanu
authors.initials: S
authors.lastname: Datta
authors.forename: Leila C
authors.initials: LC
authors.lastname: Kahwati
mesh_terms: D003376:Counseling; D003669:Deductibles and Coinsurance; D006301:Health Services Needs and Demand; D006801:Humans; D015431:Weight Loss
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