The Past, Present, and Future of Demand for Bariatric Surgery in Chile: A Subgroup Analysis for no-income (Group A) FONASA Beneficiaries

Author(s)

Daniela Paredes, BSc, MPH1, Rony C. Lenz, BEc, MA, MD2, Rodrigo Muñoz Claro, MD, PhD3;
1Medtronic, Health Economics & Reimbursement, Santiago, Chile, 2Lenz Consultores, Santiago, Chile, 3Sociedad Chilena de Cirugía Bariátrica y Metabólica, Santiago, Chile
OBJECTIVES: In 2022, the public insurer FONASA introduced a Bundled Payment program to co-finance bariatric surgeries performed by private providers. Eligible patients must meet specific clinical and income criteria, excluding a subgroup of lower-income individuals from access despite their clinical eligibility. This study aims to characterize the past, present, and future demand within this no-income patient segment (Group A).
METHODS: A descriptive, retrospective, longitudinal study was conducted using open, anonymized secondary data on hospital discharges from 2022 to 2023 to analyze past and present demand. For projections of future demand, a funnel-down technique was employed, integrating sociodemographic (gender, age range, insurance, income group, region) and clinical data (BMI, major and mild comorbidities) with biostatistical expansion of national health registries at regional and national levels.
RESULTS: Historically, before PAD implementation, 620 bariatric surgeries were conducted in Chile, with 274 (21.3%) involving Group A patients. During PAD implementation, PAD surgeries increased to 13,120 in the first year and 21,140 in the second year, while non-PAD bariatric surgeries decreased to 375, with only 75 cases (20.0%) involving Group A cases nationwide. Despite this, the projected effective demand for bariatric surgery in Group A by 2025 is 133,553 women and 46,330 men, totaling 179,884 clinically eligible patients who are not PAD-eligible due to no co-payment capacity and no-income. These cases lack prioritization in any coverage scheme.
CONCLUSIONS: The no-income Group A remains a non-prioritized segment under PAD implementation, highlighting the need for targeted strategies to address this gap. Having no special programs to address 179K patients could exacerbate obesity-associated inequities.

Conference/Value in Health Info

2025-05, ISPOR 2025, Montréal, Quebec, CA

Value in Health, Volume 28, Issue S1

Code

P20

Topic

Health Policy & Regulatory

Topic Subcategory

Health Disparities & Equity, Insurance Systems & National Health Care

Disease

No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)

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