Costly Hurdles for Bariatric Surgery

It’s hard to say exactly why we’ve put so many hurdles in the way of effective obesity care. But a new analysis in Medical Care shows us that these are costly hurdles. David Kim, David Arterburn, Sean Sullivan, and Anirban Basu find that cost sharing for bariatric surgery is a bad idea. Payers lose $7 million from the value of healthcare services because patients give up on bariatric surgery. The out-of-pocket costs for some patients are simply too high.

As a result, diabetes progresses, when it could have been put into remission. Treatment gets more costly and less effective. Complications multiply.

Targeting Obesity and Type 2 Diabetes

Kim et al focused their analysis on people with both significant obesity (BMI>40) and type 2 diabetes. In this population, the case for bariatric surgery is especially clear. Surgery can produce remissions in diabetes at a rate that even intensive medical care simply cannot match.

Despite these obvious medical benefits, many health plans are in the habit of shifting a heavy cost burden for these surgeries to the patient. On average, patients wind up paying roughly $2,000 out of pocket when they have bariatric surgery. This is the cost for people who actually have coverage. For those who don’t, the full cost comes to an average around $25,000.

A Stupid Barrier

Needless to say, thousands of dollars out of pocket is a significant barrier for many people who need bariatric surgery. And these data make it clear that it’s a stupid one.

How do they justify it? A thought leader in a large managed care organization told us recently that their system could simply not afford it:

Fortunately, we have enough hurdles for those obese people that few of them make it through to get bariatric surgery. We don’t need to be spending all that money on surgery and drugs when exercise works so well. But if a patient with severe obesity demands the surgery, they’re eventually going to get it.

Does exercise work so well for obesity, as he says? One can certainly improve health. But objective data does not support the claim that it’s an adequate substitute for bariatric surgery. So we can only surmise that these costly hurdles continue to exist for two reasons. Persistent bias against people with obesity is one. And because of that bias, health plans can get away with it.

It’s time to stop. Health plans are penalizing themselves, not to mention their members.

Click here for the study in Medical Care.

Hurdle, photograph © Craig Rodway / flickr

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Month 29, 2018