Who Should Pay for Obese Health Care?

Photo: Paying extra to use special equipment for severely obese patients; bariatric ambulance

When paramedics come to the rescue, they typically look for vital signs first -- breathing, a pulse. But in more communities each year, paramedics might also be sizing up the patient to see if a bariatric ambulance specially designed to carry severly obese people needs to be called.

Topeka, Kan., is one of at least 30 communities across the United States that has commissioned ambulances with a specialized cot, ramp and winch to lift patients who weigh more than 350 pounds, according to ABC News affiliate KTKA in Topeka.

Patients who need the special ambulances in Topeka will be charged more money for the service -- $1,172 rather than $629, plus $16 per mile rather than $11.

After a decade of spiraling weight problems in America, hospitals across the country are responding with bariatric specialized care -- from floor-mounted toilets to specialized prenatal clinics for obese women.

"We really think this helps provide dignity to a patient," said Douglas Moore, public relations manager for American Medical Response, a private ambulance service that operates in 43 states and is the developer of the "bariatric" ambulance used in Topeka's Shawnee County. The company's first bariatric ambulance debuted in 2002, and they have spread across the country ever since.

"A lot of our profession is lifting patients from the cot into the bed," he said.

Moore said clients across the country, including fire departments, occasionally have had to call for backup to lift severely obese patients.

Obesity activists reacted with disdain to the practice of charging more for use of the new bariatric equipment, especially in a service funded by taxpayers.

"Increasing that rate from $629 to $1,172 is price gouging, and it's targeting a particular group of people," said Barbara Thompson, vice chairman of the Obesity Action Coalition in Tampa, Fla. "It can be looked at no other way than discriminating against them."

AMR markets the higher charge as a solution to cities, counties and towns that respond frequently to such patients at an extra cost to ... someone.

"We don't advertise this as a bariatric ambulance. ... You wouldn't know that it was a different ambulance on the outside," said Moore. "We do advertise it to the hospital."

Paying for Specialized Obesity Care

Many ambulance services and hospitals do not charge the patient directly for the specialized services. But it will cost something to continually serve such patients or keep up with the obesity rates. In 1999, 32 states had an obesity rate below 20 percent. Today, only one state has an obesity rate below 20 percent.

"We look at it as an investment in service and quality versus an additional cost that we have to pass off on somebody," said Steve Lawler, president of Pitt County Memorial Hospital in Greenville, N.C.

Similar to a sub-specialty in geriatrics, Lawler said Pitt County Memorial Hospital has worked with the American Nurses Association to develop an accreditation for bariatric nursing. The hospital also has invested in lifts and special beds to accommodate bariatric patients in or outside of the bariatric surgery center.

"It [the change] really has been over the last two years," said Lawler. "It's reflective in regards to what's going in health care and what's going on in health reform."

Perhaps spurred either by the idea of changing the focus of hospitals and health care, or by sheer logistics, hospitals in many areas are implementing similar renovations.

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