The role of price, sociodemographic factors, and health in the demand for bariatric surgery

Abstract

Objectives: To estimate the effect of price, sociodemographic factors, and health on the demand for bariatric surgery among eligible individuals with private health insurance, in order to enable policy makers and insurers to make more informed decisions concerning access to care for bariatric surgery.

Study design: We conducted an Internet-based contingent valuation survey of 1802 obese persons eligible for bariatric surgery but who had not undergone the procedure.

Methods: We used multivariate regression analysis to separately estimate the likelihood of having gastric bypass and gastric banding surgery at different out-of-pocket costs. We combined the results with estimates of the privately insured bariatric surgery-eligible population from the National Health and Nutrition Examination Survey, 1999-2002, to estimate aggregate demand.

Results: Out-of-pocket cost was negatively and highly significantly related to the self-reported likelihood of having surgery. Persons with higher incomes and younger persons also reported a significantly higher likelihood of surgery. No effect was found for body mass index or for most comorbidities. We estimate that about 150 000 bariatric operations per year would be demanded by those with private health insurance at an out-of-pocket cost of USD 25 000. At USD 5000, we estimate a demand of 250 000 bariatric operations per year.

Conclusions: Price is significantly and negatively related to the demand for bariatric surgery. At an out-of-pocket cost of USD 5000, about 2.2% of the bariatric surgery-eligible population would strongly consider surgery.