Bariatric Surgery More Common, Less Expensive with Private Insurance

Janani Thapa, PhD

Results from a new study suggest people with public insurance are paying more than privately insured patients when undergoing bariatric weight loss surgery.

The first study to examine the surgeries by insurance payer type, results of the study raise a red flag on a trend with serious real-world implications given the continued rise in obesity and bariatric procedures in the US.

"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 investigator Janani Thapa, PhD, an assistant professor of health policy and management in UGA's College of Public Health, in a statement.

Currently, treatment of obesity represents a unique and pressing issue in the US and aboard. While data indicates more than one-third of US citizens are considered obese, disparities in prevalence based on socioeconomic status as well as race and ethnicity.

"The hoops that they have to jump through may be more (than others) to access the surgery and that was our motivation to look into this,” added Thapa.

With these patient populations more likely to use public insurance, investigators sought to assess potential disparities based on insurance type and surgical treatment using data form the National Inpatient Sample (NIS).

Using NIS data from 2011-2014, investigators obtained data related to adult patients 18 years of age and older with a diagnosis of obesity, which were verified using ICD-9-CM codes. With this data, investigators carried out their 3-part analysis.

The first part of the analyses examined trends in prevalence of diagnosed obesity among all hospitalizations and proportion of bariatric surgeries among those patients. The second portion assessed these trends according to age groups, sex, race, and payer types. The final portion of the analysis was designed to assess the cost per input-patient hospitalization for bariatric surgery by payer type and estimated total costs.

Age groups for the analysis were defined as 18-34 years, 35-54 years, 55-64 years, and 65 years or older. Payer types were classified as Medicaid, Medicare, private, and self-insured or other.

Results of the analysis indicated the prevalence of obesity and number of obesity surgeries increased across all subgroups examined during the study period. Overall, bariatric surgeries were most common in patients 33-54 years old with private insurance—however, an in-patient obesity diagnosis was most likely among women, non-Hispanic Blacks, and those with public insurance.

Results of the analysis also indicated patients with private insurance were more than twice as likely to undergo bariatric surgery than their counterparts with Medicare or Medicaid (P <.001)—privately insured patients were also more likely to undergo bariatric surgery than those classified as self-insured or other.

Additionally, results indicated patients with Medicare or Medicaid had higher average in-patient costs for bariatric surgery than their counterparts with private insurance. Investigators pointed out this pattern was consistent across all 4 years examined in the study.

This 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,” was published in Clinical Obesity.