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Excerpts from FULLY PAID QUIT-SMOKING PLANS WORK BEST, STUDY SAYS

Fewer employees participate when they have to pay for a portion of the cessation programs

By Laura Beil and Charles Ornstein, Dallas Morning News [09/03/98]

columnists The number of workers who quit smoking increases when employers fully cover the cost of cessation programs offered by insurance companies, according to a new study.

The results challenge the common belief among employers that smokers should be motivated enough to pay for at least part of their counseling, nicotine patches and other aids.

"If employers want to reduce the prevalence of smoking, then their best bet would be to get full coverage of smoking cessation," said Louis Grothaus of the Group Health Cooperative of Puget Sound, a consumer-owned HMO that covers about 450,000 people in western Washington state.

In a study published in Thursday's issue of the New England Journal of Medicine, Mr. Grothaus and his colleagues compared four different levels of coverage for stop-smoking programs in 1993 and 1994.

In some cases, smoking cessation was a fully covered benefit. With other plans, patients paid half the cost. Although the employees who had a co-payment were indeed more likely to quit over the term of the study, four times as many people attempted to kick the habit when the program was a covered benefit.

About 3 percent of the smokers who had full coverage in the HMO were able to quit in a given year. With the standard coverage, only 1 percent of the HMO's smokers stopped. The study, conducted in Washington state, was sponsored by a grant from the Tobacco Policy Research and Evaluation Program of the Robert Wood Johnson Foundation.

Some local employers said they would be willing to pay higher premiums if they were convinced that full coverage for smoking cessation programs paid off. But companies generally appear more interested in improving short-term medical outcomes than changing employee behavior.

"Most companies give [smoking cessation] lip service, if that, because the payoff is really long term," said George Crowling, regional health-care manager for GTE Corp. in Irving, "In general, companies say, 'Geez, suppose I support this program, in 20 years he may not get cancer, but in six months he may be out of here.'

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