Do Insurance-mandated Precertification Criteria and Insurance Plan Type Determine the Utilization of Bariatric Surgery Among Individuals With Private Insurance?
Do Insurance-mandated Precertification Criteria and Insurance Plan Type Determine the Utilization of Bariatric Surgery Among Individuals With Private Insurance?
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DOI：
10.1097/mlr.0000000000001358
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发表时间：
2020-11
期刊：
影响因子：
3
通讯作者：
Sarwer DB
中科院分区：
文献类型：
--
作者：
Gasoyan H;Soans R;Ibrahim JK;Aaronson WE;Sarwer DB
保险公司以多种方式限制接受减肥手术，包括预先认证标准，如3-6个月的术前监督医疗体重管理和2年的体重史记录。在控制潜在的社会人口学混杂因素后，调查上述预认证标准、保险计划类型和接受减肥手术的可能性之间是否存在关联。该研究使用宾夕法尼亚州卫生保健成本控制理事会2016年在宾夕法尼亚州5个县的数据和坦普尔大学减肥手术计划保存的术前保险要求记录进行。私人保险的减肥手术患者和个人谁符合资格标准，但没有接受手术的确定和1：1匹配的性别，种族，年龄组和邮政编码（n = 1,054）。数据分析采用单因素检验和Logistic回归分析。在控制保险计划类型和记录体重史的要求后，3-6个月术前监督医疗体重管理的保险要求与接受手术的几率较小相关（比值比[OR] = 0.459，95%置信区间[CI] 0.253-0.832，P = 0.010）。首选提供商组织（OR = 1.422，95%CI 1.063-1.902，P = 0.018）和按服务收费（OR = 1.447，95%CI 1.021-2.050，P = 0.038）计划与接受手术的几率更大相关，与健康维护组织计划相比，在控制了所研究的预认证要求后。记录的体重史要求不是接受手术的几率的显著预测因素（P = 0.132）。有必要考虑保险福利设计作为获得减肥手术的决定因素。
Access to bariatric surgery is restricted by insurers in numerous ways, including by precertification criteria such as 3-6 months preoperative supervised medical weight management and documented 2-year weight history. To investigate if there is an association between the aforementioned precertification criteria, insurance plan type, and the likelihood of undergoing bariatric surgery, after controlling for potential sociodemographic confounders. The study was conducted using the Pennsylvania Health Care Cost Containment Council’s data in 5 counties of Pennsylvania in 2016 and records of preoperative insurance requirements maintained by the Temple University Bariatric Surgery Program. Privately insured bariatric surgery patients and individuals who met the eligibility criteria but did not undergo surgery were identified and 1:1 matched by sex, race, age group, and zip code (n = 1,054). Univariate tests and logistic regression analysis were utilized for data analysis. The insurance requirement for 3-6 months preoperative supervised medical weight management was associated with smaller odds of undergoing surgery (odds ratio [OR] = 0.459, 95% confidence interval [CI] 0.253-0.832, P = 0.010), after controlling for insurance plan type and the requirement for documented weight history. Preferred provider organization (OR = 1.422, 95% CI 1.063-1.902, P = 0.018) and fee-for-service (OR = 1.447, 95% CI 1.021-2.050, P = 0.038) plans were associated with greater odds of undergoing surgery, compared with health maintenance organization plans, after controlling for the studied precertification requirements. The documented weight history requirement was not a significant predictor of the odds of undergoing surgery (P = 0.132). There is a need for consideration of insurance benefits design as a determinant of access to bariatric surgery.