Economía de la Salud y Reembolso Medtronic Latinoamérica Sur, Santiago, Chile.
Sociedad Chilena de Cirugía Bariátrica y Metabólica, Santiago, Chile.
Medwave. 2024 Jan 3;24(1). doi: 10.5867/medwave.2024.01.2762.
More than 600 thousand people in Chile live with morbid obesity. Effective, safe, cost-effective therapeutic interventions are critical for healthcare systems and insurance schemes. In 2022, two bundled payment codes for bariatric surgery (gastric bypass and gastric sleeve) were incorporated into the National Health Fund's free-choice modality fee scheme. The objective was to characterize the execution of this payment mechanism program associated with bariatric surgery diagnosis in its first year of implementation.More than six hundred thousand people in Chile are estimated to live with morbid obesity. Effective, safe, cost-effective therapeutic interventions are critical for health systems and insurance schemes. In 2022, FONASA incorporated two Bariatric Surgery codes into the Free Choice Modality: Gastric Bypass and Sleeve Gastrectomy. Our objective was to characterize the execution of the Bariatric Surgery Bundled Payment Program in its first year of implementation.
Descriptive and observational study of the pragmatic approach of the national execution of the payment associated with diagnosis in bariatric surgery. We examined sociodemographic variables (sex, age brackets, and National Health Fund tranches) and characterization of surgeries by code broken down by public or private provider, period of issue, unit cost, co-payment, and medical loans between March and December 2022.
We recorded n = 13 118 surgeries (45.81% bypass versus 54.19% sleeve), of which n = 2424 (18.48%) used medical loans. A total of 85.01% (p = 0.01) of the procedures were in women, in people between 35 and 39 years of age (20.15%), and 45.12% in beneficiaries of tranche B. Private providers performed a total of 99.21% of the surgeries. Ten accounted for 50% of the activity (range n = 1200 to 426 surgeries per year; n = 4.8 to 1.7 surgeries per working day). Total program expenditure was $71 626 948 350 CLP, accounting for 5.04% of the total activity of the national Diagnosis Associated Payment Program.
The implementation of this bariatric surgery voucher benefited more than 13 thousand people living with obesity, mostly women of productive ages and with purchasing capacity. As an equity strategy, regardless of the access route through the voucher, it will be important to safeguard the activity in the public network.
智利有超过 60 万人患有病态肥胖症。有效的、安全的、具有成本效益的治疗干预措施对医疗保健系统和保险计划至关重要。2022 年，国家健康基金的自由选择模式费用计划纳入了两种用于减重手术（胃旁路术和胃袖状切除术）的捆绑支付代码。目的是描述该支付机制计划与实施的第一年相关的肥胖症诊断的执行情况。智利估计有超过 60 万人患有病态肥胖症。有效的、安全的、具有成本效益的治疗干预措施对医疗保健系统和保险计划至关重要。2022 年，FONASA 将两种减重手术代码纳入了自由选择模式：胃旁路术和袖状胃切除术。我们的目标是描述捆绑支付计划在实施的第一年的执行情况。
对全国执行与肥胖症诊断相关的支付情况的实用方法进行描述性和观察性研究。我们检查了社会人口统计学变量（性别、年龄组和国家健康基金阶层）以及按公共或私人提供者、发布期、单位成本、共付额和 2022 年 3 月至 12 月期间的医疗贷款细分的手术特征。
我们记录了 n = 13118 例手术（45.81%为旁路手术，54.19%为袖状手术），其中 n = 2424 例（18.48%）使用了医疗贷款。总共 85.01%（p = 0.01）的手术是女性，年龄在 35 至 39 岁之间（20.15%），45.12%的手术是 B 级受益人的手术。私人提供者共完成了 99.21%的手术。前 10 名占活动的 50%（范围 n = 1200 至 426 例手术/年；n = 4.8 至 1.7 例/个工作日）。该计划的总支出为 71626948350 智利比索，占国家诊断相关支付计划总活动的 5.04%。
该减重手术代金券的实施使超过 13000 名肥胖症患者受益，这些患者大多为育龄妇女，具有购买能力。作为一项公平战略，无论通过代金券获得途径如何，重要的是要维护公共网络中的活动。
