Farewell to Fatso?

Two recent Boston Globe headlines on Tufts Health Plan may be related

The layoff is to reduce administrative costs as Tufts tries hard to compete with Blue Cross, Harvard Pilgrim and Fallon. The restriction on obesity surgery is a cost reduction exercise, too. The Globe article and other commentators have focused on the effect on individual patients…

Doctors condemned the new policy, which takes effect March 6, saying Tufts is ignoring a growing body of clinical evidence that shows that such operations help those who have exhausted other methods to lose weight. Delaying surgery worsens conditions such as diabetes and heart disease that are often complications of pronounced weight gain, they said.

“This is Draconian,” said Dr. Philip Schauer , president of the American Society for Bariatric Surgery and director of bariatric surgery at the Cleveland Clinic. “This flies in the face of the medical evidence. These policies sentence a patient to a life of dealing with obesity without the possibility of parole.”

…but it seems plausible to me that Tufts is looking for ways to dump obese patients out of its plans and onto its competitors. Beyond the considerable money saved from not covering bariatric surgery, Tufts may benefit from a healthier, lower cost patient mix. Not only will obese people quit Tufts, but some non-obese people may actually select Tufts for taking a hard line against members they think may be driving up their own insurance costs.

Then again, it’s certainly possible that Tufts is doing what it says it is: making a decision that saves costs and improves patients’ health.

February 16, 2007

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