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Users of public insurance pay more bariatric surgery

Tue, 07/14/2020 - 08:58
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Users of public insurance are paying more for bariatric surgery compared to private insurance patients, according to researchers the University of Georgia. The investigators believe the study, 'In‐patient obesity diagnosis, use of surgical treatment and associated costs by payer type in the United States: Analysis of the National Inpatient Sample, 2011 through 2014', published in Clinical Obesity, is the first to break down surgeries by insurance payer type (public versus private insurance) to better understand the economic burden on patients and US health care system overall.

Dr Janani Rajbhandari-Thapa (Credit: UGA's College of Public Health)
Dr Janani Rajbhandari-Thapa (Credit: UGA's College of Public Health)

"Bariatric surgery is becoming more common, but there's increasing evidence that bariatric surgery is not happening consistently across all payer types, and there might be cost differences by payer type," said lead study author, Dr Janani Rajbhandari-Thapa, an assistant professor of health policy and management in UGA's College of Public Health. "The hoops that they (Medicaid or Medicare patients) have to jump through may be more [than others] to access the surgery and that was our motivation to look into this."

These differences could point to inequities in health care access that make it more difficult for patients who have Medicaid or Medicare to qualify or pay for bariatric surgery when they need it. Obesity rates are highest among low-income Americans; this also tends to be a group with less access to obesity treatment options, including bariatric surgery.

The team analysed a national dataset of hospitalised patients from 2011 to 2014, looking for trends in bariatric surgery use, costs across insurance types and other demographic factors.

They found a statistically significant increase in the proportion of (a) hospitalised patients diagnosed with obesity, and (b) bariatric surgery among those diagnosed with obesity and among different socio‐demographic and insurance groups. Despite the increase in the national in‐patient cost, the average in‐patient cost per hospitalisation associated with bariatric surgery decreased from 2012 to 2014.

But they also found that while on average individual patients are paying less for the surgery, the overall cost burden was highest for publicly insured patients. The average cost per surgery was highest among Medicare patients.

Thapa added they can't say why that is, but "as soon as we talk about public insurance, it is taxpayer money that is paying for the surgery.”

The next step, the authors said, is to investigate the long-term health outcomes and medical costs of the weight loss surgery.

Despite the study's focus on one clinical intervention, Thapa and her co-authors still advocate for prevention as the best way to reduce the burden of obesity on individuals and the system.