California HMO Coverage of Tobacco Dependence Treatments for Pregnant Smokers Limited, Study Says
Although smoking during pregnancy creates long-substantiated health risks to the fetus, many California managed care companies did not offer smoking cessation services to pregnant smokers in 1997, according to a study published in this month's American Journal of Public Health. Dr. Kate Pickett of the University of Chicago surveyed coverage of prenatal tobacco dependence treatments at 39 full-service California HMOs in 1997. The survey assessed treatment availability, accessibility, use and effectiveness of services offered to pregnant women who smoke, addressing individual, group and telephone counseling and self-help kits. Of the HMOs surveyed, 36 covered at least one treatment, including three that covered all four services, and three did not cover any tobacco dependence treatments for pregnant women. In addition to the four services examined, 17 HMOs covered at least one additional smoking cessation service -- such as nicotine replacement therapy -- for pregnant women. Coverage ranged from a low of 44% of insurers providing self-help kits and individual counseling, to a high of 56% providing telephone counseling. Of the HMOs covering any services, only 67% monitored utilization, such as keeping lists of participants, and only 27% of these monitored the quit rates for pregnant smokers. Eighty-two percent of the 39 HMOs studied reported that their providers screen all pregnant women for smoking, while 18% did not know whether providers screened for tobacco use.
Because providers of Medi-Cal managed care plans are required to identify and intervene on pregnancy risks, Medi-Cal plans were more likely to cover individual and group counseling sessions compared to commercial HMOs. Consequently, Medi-Cal members had better access to "the most effective, clinically intensive tobacco dependence treatment services." The researchers concluded, "Although managed care offers the potential for increasing the availability and accessibility of such services for plan members, this survey suggests that that potential is not being realized. ... [M]any California HMOs are unable to judge the use and effectiveness of these services, and can neither track the costs and benefits of existing programs nor determine the need for additional services." The U.S. surgeon general in June 2000 recommended in its clinical practice guidelines for smoking cessation programs that "whenever possible pregnant smokers should be offered extended or augmented psychosocial interventions that exceed minimal advice to quit" (Pickett et al., American Journal of Public Health, September 2001).