Impact of Insurance Plan Design on Bariatric Surgery Utilization

BACKGROUND: Bariatric surgery is underutilized in the United States. OBJECTIVES: This study examined whether utilization of bariatric surgery is associated with payer and insurance plan type, after removing potential socio-demographic confounders. SETTING: The study used Pennsylvania Health Care Cost Containment Council’s data in five counties of Pennsylvania from 2014–2016. METHODS: Bariatric surgery patients and eligible patients who did not undergo surgery were identified and 1:1 matched by age, sex, race, and zip code (n=5,114). A logistic regression was performed to investigate the association of payer type and insurance plan within payer type with odds of undergoing bariatric surgery. RESULTS: The odds of undergoing bariatric surgery were not statistically different based on payer type. Medicare preferred provider organization (PPO) plan was associated with greater odds of undergoing surgery, OR = 2.49, 95% CI [1.23; 5.04], p = 0.01, compared to Medicare health maintenance organization (HMO). Medicaid fee for service (FFS) plan was associated with smaller odds of undergoing surgery, OR = 0.04, 95% CI [0.005; 0.27], p = 0.001, compared to Medicaid HMO. Individuals with Blue Cross PPO, OR = 2.43, 95% CI [1.83; 3.24], p < 0.001, Blue Cross FFS, OR = 1.79, 95% CI [1.32; 2.43], p < 0.001, and Blue Cross HMO, OR = 1.85, 95% CI [1.39; 2.46], p < 0.001, had greater odds of undergoing surgery compared to those with other commercial HMO plans. CONCLUSIONS: Specific aspects of insurance plan design, rather than more general payer type, is more strongly associated with the utilization of bariatric surgery. Further investigations could identify which components of insurance plan design have the greatest influence on the utilization of bariatric surgery.