18 Oct Bariatric Surgery: For Black and Hispanic Patients Providing Insurance Not Enough to Improve Access
MedicalResearch.com Interview with:
Amresh D. Hanchate, PhD
Professor, Department of Social Sciences and Health Policy
Director, Program in Health Services Research
Division of Public Health Sciences
Wake Forest School of Medicine
Medical Center Boulevard
Winston-Salem, NC 27157-1063
MedicalResearch.com: What is the background for this study?
Response: There is strong evidence of increase in access to outpatient physicians among low income individuals who gained Medicaid following changes initiated with the Affordable Care Act. But there is little evidence of whether Medicaid expansion has similarly resulted in increased use of elective inpatient procedures.
Bariatric surgery is a particularly important service to study, as the number of adults with severe obesity continues to grow in the United States, and this is the most effective available treatment. Additionally, bariatric procedures are primarily performed among the age group targeted by Affordable Care Act expansions (18-64), and there is a lot of evidence that only a small fraction of eligible uninsured patients are having surgery.
MedicalResearch.com: What are the main findings?
Response: We used data covering 63 percent of the national population, including 11 states that expanded Medicaid and 6 states that did not. We found that over the 4 years after expansion (2014-2017), use of bariatric surgery went up 31 percent each year among non-Hispanic White individuals with Medicaid coverage or who were uninsured. But we did not see a significant change in uptake of bariatric surgery among non-Hispanic Black and Hispanic individuals.
MedicalResearch.com: What should readers take away from your report?
Response: It shows that, before the ACA’s Medicaid expansion, lack of insurance may have been a major barrier for a lot of low-income patients eligible for bariatric surgery. However, providing insurance, while a necessary step towards improving bariatric surgery access, was not sufficient for Black and Hispanic patients in our study. For these populations, there may be other barriers to uptake of bariatric surgery that still need to be removed. Future studies could examine, for example, whether they are less likely to be referred by their primary care physicians for surgical evaluation or more likely to be excluded during the preapproval process.
Finally – there are almost certainly other structural barriers facing minority patients, including ongoing racism and discrimination.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We need to find out why Black and Hispanic patients, who are otherwise eligible for the treatment, not getting it.
Any disclosures?: This study was funded by a NIH grant. I have no other disclosures.
Hanchate AD, Qi D, Paasche-Orlow MK, et al. Examination of Elective Bariatric Surgery Rates Before and After US Affordable Care Act Medicaid Expansion. JAMA Health Forum. 2021;2(10):e213083. doi:10.1001/jamahealthforum.2021.3083
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