保险强制审批标准和保险计划类型是否决定了有私人保险的个体对减重手术的利用？
Do Insurance-mandated Precertification Criteria and Insurance Plan Type Determine the Utilization of Bariatric Surgery Among Individuals With Private Insurance?
机构信息
Department of Health Services Administration and Policy, College of Public Health, Temple University.
Bariatric Surgery Program, Temple University Hospital.
出版信息
Med Care. 2020 Nov;58(11):952-957. doi: 10.1097/MLR.0000000000001358.
BACKGROUND
Access to bariatric surgery is restricted by insurers in numerous ways, including by precertification criteria such as 3-6 months preoperative supervised medical weight management and documented 2-year weight history.
OBJECTIVES
To investigate if there is an association between the aforementioned precertification criteria, insurance plan type, and the likelihood of undergoing bariatric surgery, after controlling for potential sociodemographic confounders.
RESEARCH DESIGN
The study was conducted using the Pennsylvania Health Care Cost Containment Council's data in 5 counties of Pennsylvania in 2016 and records of preoperative insurance requirements maintained by the Temple University Bariatric Surgery Program.Privately insured bariatric surgery patients and individuals who met the eligibility criteria but did not undergo surgery were identified and 1:1 matched by sex, race, age group, and zip code (n=1054). Univariate tests and logistic regression analysis were utilized for data analysis.
RESULTS
The insurance requirement for 3-6 months preoperative supervised medical weight management was associated with smaller odds of undergoing surgery [odds ratio (OR)=0.459; 95% confidence interval (CI), 0.253-0.832; P=0.010], after controlling for insurance plan type and the requirement for documented weight history.Preferred provider organization (OR=1.422; 95% CI, 1.063-1.902; P=0.018) and fee-for-service (OR=1.447; 95% CI, 1.021-2.050; P=0.038) plans were associated with greater odds of undergoing surgery, compared with health maintenance organization plans, after controlling for the studied precertification requirements. The documented weight history requirement was not a significant predictor of the odds of undergoing surgery (P=0.132).
CONCLUSIONS
There is a need for consideration of insurance benefits design as a determinant of access to bariatric surgery.
背景
保险公司以多种方式限制接受减重手术，包括术前认证标准，如 3-6 个月术前监督医疗体重管理和记录的 2 年体重史。
目的
在控制潜在的社会人口混杂因素后，调查上述术前认证标准、保险计划类型与接受减重手术的可能性之间是否存在关联。
研究设计
该研究使用宾夕法尼亚州医疗保健成本控制委员会在宾夕法尼亚州 5 个县的 2016 年数据和天普大学减重手术项目维护的术前保险要求记录进行。确定了私人保险的减重手术患者和符合条件但未进行手术的个体，并按性别、种族、年龄组和邮政编码（n=1054）进行 1:1 匹配。采用单变量检验和逻辑回归分析进行数据分析。
结果
术前 3-6 个月监督医疗体重管理的保险要求与手术可能性降低相关[优势比（OR）=0.459；95%置信区间（CI），0.253-0.832；P=0.010]，在控制保险计划类型和记录体重史的要求后。在控制研究的术前认证要求后，与健康维护组织计划相比，首选提供商组织（OR=1.422；95%CI，1.063-1.902；P=0.018）和按服务收费（OR=1.447；95%CI，1.021-2.050；P=0.038）计划与手术可能性增加相关。记录体重史的要求不是手术可能性的显著预测因素（P=0.132）。
结论
需要考虑保险福利设计作为获得减重手术的决定因素。
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