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Shifting Coverage: Evolving Trends in Insurance for Bariatric Surgery and Persistent Disparities
Samuel Butensky
*1, Safraz A. Hamid
1, Elena Graetz
2, Eric Schneider
1, Karen Gibbs
11Department of Surgery, Yale University School of Medicine, New Haven, CT; 2Department of Biostatistics, Yale University School of Medicine, New Haven, CT
Background:
Metabolic and bariatric surgery (MBS) is the most effective long-term treatment for severe obesity, but access is influenced by insurance, socioeconomic status, and regional policies. Understanding insurance trends among MBS patients is crucial for identifying opportunities or disparities. This study examines shifts in insurance coverage over time among patients undergoing sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), focusing on variations by region, race, and procedure type amid evolving U.S. healthcare policies.
Study Design:
A retrospective analysis using data from the National Inpatient Sample (NIS) from 2016 to 2022 was conducted, identifying patients with a primary diagnosis of obesity who underwent either sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Trends in insurance coverage among patients undergoing MBS were examined over time and compared by region, race, and surgical procedure using Chi-square tests.
Results:
A total of 1,225,934 patients met the inclusion criteria. Overall, the total number of patients increased annually. From 2016 to 2022, the proportion of Medicare-insured MBS patients declined from 14.1% to 10.8%, while proportionally private insurance coverage decreased from 62.4% to 56.7%. In contrast, Medicaid and self-pay coverage increased proportionally from 10.0% and 3.7% in 2016 to 24.9% and 4.6% in 2022, respectively. These trends were consistent across years by region, procedure and race. Overall, across the study period, the Northeast had the highest proportion of Medicaid-insured patients (29.1% vs. Midwest 17.2% vs. South 12.5% vs. West 24.7%, p<0.001), while the South had the highest proportion of self-pay patients (6.9% vs. Midwest 3.1% vs. Northeast 1.6% vs. West 2.2%), p<0.001). Overall, Hispanic patients were less likely to be covered by Medicare (7.7% vs. White 14.1% vs. Black 12.4%, p<0.001) or private insurance (50.5% vs. White 63.7% vs. Black 59.2%), but had the highest Medicaid enrollment (34.5% vs. White 14.5% vs. Black 24.1%, p<0.001). Additionally, Hispanic patients were more likely to self-pay for MBS, particularly in the South, where 14.6% relied on self-pay.
Conclusions:
From 2016 to 2022, we saw insurance coverage shifts in MBS, with declines in Medicare and private insurance and increases in Medicaid and self-pay. Trends varied by region and race, with Hispanic patients more reliant on Medicaid or self-pay, especially in the South. Regional differences suggest state policies and healthcare infrastructure influence access. As MBS expands, targeted policies are needed to address disparities and ensure equitable care for all patients.
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