Utilization rate of bariatric surgery in an employee-based healthcare system following surgery coverage.

Incidence rates for obesity co-morbidities are high for individuals with class III morbid obesity. Bariatric surgery resolves/improves these co-morbidities, along with reduction in healthcare costs. Despite surgery benefits, payors are reluctant to provide coverage for fear of increased demand and costs. This study examines surgery utilization rates following coverage by an employee-based healthcare system. Bariatric surgery utilization rates were measured 1 year before and after healthcare coverage. The data show before coverage that 18 persons had bariatric surgery for a utilization rate of 1.71%. In the year after surgery, 16 persons elected to have bariatric surgery for a utilization rate of 1.42%. These findings should help to dispel the notion by employee-based insurers that coverage of bariatric surgery will lead to high utilization and associated costs in the early-coverage period.

Cost-return prediction in morbidly obese employees following weight loss interventions: a study framework.

Obesity and its many complications potentially can collapse most medical plans, unless attempts at prevention and therapy become more effective and widespread. An important incentive for providing effective treatment is proper reimbursement. We present here an evaluation of the feasibility, constrains and requirements for comparative cost-effectiveness evaluation of weight loss intervention from the payer's and employer's points of view, and propose a general framework for this type of studies toward decision making.