This American Journal of Preventive Medicine article presents findings from a mixed-methods case study that examined how coverage affected utilization of intensive health behavior counseling. The study found that when counseling designed to help patients lose weight and quit smoking was available for free, approximately one in five patients with an unhealthy behavior was referred for such counseling. However, when patient charges were instituted, clinicians asked fewer patients about health behaviors (37% vs. 29%, p<0.001); clinicians offered fewer patients referrals (29% vs. 6%, p<0.001); and patients were less interested in accepting referrals (76% vs. 14%, p<0.001). In interviews, patients and clinicians cited cost as a major barrier.
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