The role of health insurance characteristics in utilization of bariatric surgery.
The role of health insurance characteristics in utilization of bariatric surgery.
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DOI：
10.1016/j.soard.2021.01.024
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Sarwer DB
中科院分区：
文献类型：
--
作者：
Gasoyan H;Ibrahim JK;Aaronson WE;Sarwer DB
减肥手术在美国并未得到充分利用。旨在检查宾夕法尼亚州东南部成人减肥手术患者的患者特征和保险公司类型组合的时间变化，并调查付款人类型、保险计划类型、费用分摊安排（传统医疗保险受益人之间）和减肥手术利用之间的关联。 2014-2018 年宾夕法尼亚州东南部宾夕法尼亚州医疗保健成本控制委员会的数据库。确定了所有接受最常见类型减肥手术的成年患者以及 1:1 匹配的手术患者样本和符合手术条件但未接受手术的患者。使用列联表、皮尔逊卡方检验和逻辑回归进行统计分析。五年来，接受手术的黑人（2014 年为 37.1%，2018 年为 43.0%）、西班牙裔（5.4%，2018 年为 8.0%）和医疗补助受益人（2014 年为 19.2%，2018 年为 28.5%）比例有所增加。与私人保险个人相比，仅根据付款人类型，医疗保险受益人接受减肥手术的几率存在统计差异（几率小 22%）。根据医疗保险和私人保险付款人类别中的保险计划类型，接受手术的几率存在显着差异。与拥有私人二级保险的人相比，拥有传统医疗保险计划但没有补充保险的个人和具有双重资格的个人接受手术的几率较小（分别为 42% 和 32%）。在控制了混杂的社会人口因素后，保险计划设计在确定减肥手术的利用方面可能与一般付款人类型一样重要。
Bariatric surgery is underutilized in the United States. To examine temporal changes in patient characteristics and insurer type mix among adult bariatric surgery patients in Southeastern Pennsylvania and to investigate the associations between payer type, insurance plan type, cost-sharing arrangements (among traditional Medicare beneficiaries), and bariatric surgery utilization. Pennsylvania Health Care Cost Containment Council’s databases in Southeastern Pennsylvania during 2014-2018. All adult patients who underwent the most common types of bariatric surgery and a 1:1 matched sample of surgery patients and those who were eligible for surgery but did not undergo surgery were identified. Contingency tables, Pearson Chi-Square tests, and logistic regression were used for statistical analysis. Over the five years, there was an increase in the proportion of Black individuals (37.1% in 2014 vs 43.0% in 2018), Hispanics (5.4% vs 8.0%), and Medicaid beneficiaries (19.2% in 2014 vs 28.5% in 2018) who underwent surgery. The odds of undergoing bariatric surgery based on payer type only between Medicare beneficiaries were statistically different (22% smaller odds) compared to privately insured individuals. There were significantly different odds of undergoing surgery based on insurance plan type within Medicare and private insurance payer categories. Individuals with traditional Medicare plans with no supplementary insurance and those with dual eligibility had smaller odds of undergoing surgery (42% and 32%, respectively) compared to those with private secondary insurance. Insurance plan design may be as important in determining the utilization of bariatric surgery as the general payer type after controlling for confounding socio-demographic factors.
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