Reasons for underutilization of bariatric surgery: The role of insurance benefit design

Hamlet Gasoyan, Gabriel Tajeu, Michael Halpern, David B. Sarwer

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Despite the effectiveness of bariatric surgery, both with respect to weight loss and improvements in obesity-related co-morbidities, it remains underused. Only 1% of the currently eligible population undergoes surgical treatment for obesity, with roughly 228,000 individuals receiving bariatric surgery in the United States each year. Several barriers to bariatric surgery have been identified, including limited patient and referring physician knowledge and attitudes regarding the effectiveness and safety of bariatric surgery. However, the role of insurance coverage and benefit design as a barrier to access to care has received less attention to date. Bariatric surgery is cost-effective compared with nonsurgical treatments among individuals with extreme obesity and type 2 diabetes. While it may not result in cost savings among all bariatric surgery eligible patients, for certain patient subgroups, bariatric surgery may be cost neutral compared with traditional treatment options. In addition, longer-term outcomes of bariatric surgery suggest decreased or stable costs in the long run. The purpose of this review paper was to synthesize the existing knowledge on why bariatric surgery remains largely underused in the United States with a focus on health insurance benefits and design. In addition, the review discusses the applicability of value-based insurance design to bariatric surgery. Value-based insurance design has been previously applied to bariatric surgery coverage with use of incentive-based cost-sharing adjustments. Its application could be further extended because the postoperative clinical outcomes and costs vary among the different subgroups of bariatric surgery eligible patients.

Original languageEnglish (US)
JournalSurgery for Obesity and Related Diseases
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Fingerprint

Bariatric Surgery
Insurance Benefits
Costs and Cost Analysis
Obesity
Cost Sharing
Social Adjustment
Insurance Coverage
Cost Savings
Health Insurance
Type 2 Diabetes Mellitus
Motivation
Weight Loss
Therapeutics

Keywords

  • Access to care
  • Bariatric surgery
  • Barriers
  • Utilization
  • Value-based insurance design

ASJC Scopus subject areas

  • Surgery

Cite this

Reasons for underutilization of bariatric surgery : The role of insurance benefit design. / Gasoyan, Hamlet; Tajeu, Gabriel; Halpern, Michael; Sarwer, David B.

In: Surgery for Obesity and Related Diseases, 01.01.2018.

Research output: Contribution to journalArticle

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