This article examines the influence of cost on patient use of behavioral counseling services. Smoking and obesity are two major public health challenges, but few health insurance plans cover counseling services to help individuals lose weight or stop smoking. Little is known about how the cost of behavioral counseling services affects the consumption of such services.
The authors carried out a pre-post study in which counseling services were offered to eligible patients. For the first five weeks, eligible patients referred by their physician could receive counseling services for free. For the subsequent three weeks, patients could still be referred to counseling services but would have to pay out-of-pocket for counseling. In total, 1,860 patients in the Virginia Ambulatory Care Outcomes Research Network were flagged for eligibility and 407 were referred for intensive counseling.
This study shows results from a specific intervention designed to refer eligible patients to behavioral counseling. Patients were much more likely to obtain counseling if the counseling service was free, suggesting that out-of-pocket costs are a significant deterrent to use of intensive behavioral counseling services.