The Role of Commercial Health Insurance Characteristics in Bariatric Surgery Utilization
- 7 November 2019
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 273 (6), 1150-1156
- https://doi.org/10.1097/sla.0000000000003569
Abstract
The aim of this study was to understand relationships among insurance plan type, out-of-pocket cost sharing, and the utilization of bariatric surgery among commercially insured patients. Only 1% of eligible persons undergo bariatric operations, and this underutilization is often attributed to lack of insurance coverage. But even among the insured, underinsurance is now recognized as a major barrier to accessing medical care. The relationships among commercial insurance design, out-of-pocket cost sharing, and elective surgery utilization, particularly in bariatrics, are not well understood. Retrospective review of 73,002 commercially insured members of the IBM MarketScan commercial claims database who underwent bariatric surgery from 2014 to 2017. The exposure variables were insurance plan type and out-of-pocket cost sharing. The outcome was utilization of bariatric surgery. We also examined seasonal trends in bariatric surgery utilization stratified by average levels of cost sharing. Utilization of bariatric surgery was higher in plans with lower cost sharing, such as PPOs (20 operations/100,000 enrollees) than in HDHPs (high-deductible health plans, 12.1 operations/100,000 enrollees). Overall, every $1000 increase in cost sharing was associated with 5 fewer bariatric operations per 100,000 insured lives; this association was strongest in plans with high cost sharing (high-deductible and consumer-directed health plans). Members of all plan types had higher surgical utilization in quarter 4 relative to quarter 1 of each year; these seasonal variations were also most pronounced in plans with high cost sharing. Insurance plan types with higher cost sharing have lower utilization of bariatric surgery. Underinsurance may represent a newly identified barrier to surgical care that should be addressed by advocates and policymakers.Keywords
This publication has 19 references indexed in Scilit:
- Reasons for underutilization of bariatric surgery: The role of insurance benefit designSurgery for Obesity and Related Diseases, 2018
- Breast Cancer Diagnosis and Treatment After High-Deductible Insurance EnrollmentJournal of Clinical Oncology, 2018
- Out-of-Pocket Spending and Premium Contributions After Implementation of the Affordable Care ActJAMA Internal Medicine, 2018
- Effect of High-Deductible Insurance on High-Acuity Outcomes in Diabetes: A Natural Experiment for Translation in Diabetes (NEXT-D) StudyDiabetes Care, 2018
- National Health Care Spending In 2016: Spending And Enrollment Growth Slow After Initial Coverage ExpansionsHealth Affairs, 2018
- Bariatric surgery insurance requirements independently predict surgery dropoutSurgery for Obesity and Related Diseases, 2017
- Colorectal Cancer Screening in a Nationwide High-deductible Health Plan Before and After the Affordable Care ActMedical Care, 2016
- Perceived barriers to bariatric surgery among morbidly obese patientsSurgery for Obesity and Related Diseases, 2010
- Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysisSurgery for Obesity and Related Diseases, 2010
- Refusals, denials, and patient choice: reasons prospective patients do not undergo bariatric surgerySurgery for Obesity and Related Diseases, 2007