Inconsistent efforts by health-care providers to offer proven cessation treatment is an important barrier preventing tobacco users from gaining access to effective treatments. An approach called "pay for performance" is being used to motivate health care providers to improve their delivery of proven cessation treatments.
Despite increasing national attention to the benefits of proven smoking cessation treatment, health care providers routinely fail to identify patient tobacco status. Also, their provision of cessation counseling and recommending of cessation medications and referrals to structured counseling programs for smokers are lower than they should be. Women and elderly tobacco users and those without private insurance appear to be especially unlikely to receive prescriptions for cessation medications. Patients who request treatment and those with tobacco-related health problems are more likely to get help.
In recent years there has been improvement in private, federal and state insurance coverage for some components of treatments recommended by the USPHS. For example, Medicare now provides reimbursement for counseling and pharmacotherapy.
However, insurance reimbursement for smoking cessation remains spotty. A 2002 national survey of Medical Care Organizations (MCO) revealed that 30 percent had no written policy on coverage for tobacco cessation services and 42 percent provided no coverage for behavioral interventions.
Evidence produced by SAPRP-supported investigators has helped demonstrate that MCO's would be wise to invest in comprehensive smoking cessation services. The costs of the services are low relative to the potential return on investment in the form of reduced smoking-related health care expenditures. This work has stimulated the adoption of pay-for-performance incentives by some health insurers to motivate health care providers to improve their delivery of proven cessation treatments to their tobacco using patients.
McMenamin SB, Schauffler HH, Shortell SM, Rundall TG, Gillies RR. Support for smoking cessation interventions in physician organizations: results from a national study. Medical Care. 2003;41(12):1396-1406.
McPhillips-Tangum C, Bocchino C, Carreon R, Erceg C and Rehm B. Addressing tobacco in managed care: results of the 2002 survey. Preventing Chronic Disease Public Health Research, Practice, and Policy. 2004;1(4):1-11.
Steinberg MB, Akinciquil A, Delnevo C, et al. Gender and age disparities for smoking cessation treatment. American Journal of Preventive Medicine. 2006; 30(5):405-412.
Warner KE, Mendez D, Smith DG. The financial implications of coverage of smoking cessation by managed care organizations. Inquiry. 2004;41(1):57-69.