Scarcity in access to bariatric care services: report

09 February, 2015

While bariatric surgery, a procedure to treat obesity, is becoming increasingly common in Australia, access to public-funded services is limited, new research has shown.

The limiting factor may be partly attributed to increasing numbers of private patients requiring subsequent revisions/reversals in public hospitals.

These findings are reported in "Quantitative analysis of bariatric procedure trends 2001-13 in South Australia: implications for equity in access and public healthcare expenditure" by Samantha B. Meyer et al[1], featured in February's issue of the Australian Health Review.

According to the report: "…findings from a study in New South Wales identified poor access in populations most in need, providing evidence for the 'inverse care law', whereby the groups with the greatest healthcare need receive the lowest levels of service…This is particularly the case for low-income individuals and individuals who appear to be most affected by extreme obesity."

The report said long public waiting lists and limited access to bariatric procedures through the public health system may encourage individuals who can afford to do so to take out private health insurance in order to access bariatric surgery in a more timely manner.

However some may be discontinuing their private coverage after the initial surgery and subsequently seeking further care in the public sector.

Follow-up and reversal surgeries

Based on data collected in South Australia from 2001 to 2013, the authors suggested  a factor contributing to lengthy waiting times for bariatric procedures in public hospitals may be the number of patients attending public hospitals for follow-up and reversal surgeries following initial procedures carried out in private hospitals.

Patients who may have held private insurance for the purposes of the initial surgery may be seeking remedial/reversal surgery via the public system further increasing the demand on public sector services. However, the authors note that this suggestion is not empirically supported and is in need of investigation in a prospective study.

The authors of the report called for further investigation into revision/reversal procedures, particularly the use of public facilities to carry out these procedures, and why revision/reversal procedures make up as much as 20 per cent of all bariatric procedures.

"Bariatric surgery is one of the fastest growing forms of surgery conducted in Australia, and obesity is a leading contributor to the burden of disease, yet only 10 per cent of bariatric procedures are undertaken in public hospitals," Alison Verhoeven, AHHA Chief Executive, said.

"Better access to affordable surgery is undoubtedly needed, as is better data so that we can understand how such surgery is being funded and delivered."

[1] Report authors: Samantha B. Meyer, Sue Booth, John Gray, Paul Hakendorf, Darlene McNaughton, Lillian Mwanri, Campbell Thompson, Paul R. Ward.