Geographic Inequities in Bariatric Surgery Access in Southern Chile: The Case of the Chilean Bundled Payment PAD
Author(s)
Daniela Paredes, BSc, MPH1, Rony C. Lenz, BEc, MA, MD2, Rodrigo Muñoz Claro, MD, PhD3;
1Medtronic Chile, Health Economics & Reimbursement, Santiago, Chile, 2Lenz Consultores, Santiago, Chile, 3Sociedad Chilena de Cirugía Bariátrica y Metabólica, Santiago, Chile
1Medtronic Chile, Health Economics & Reimbursement, Santiago, Chile, 2Lenz Consultores, Santiago, Chile, 3Sociedad Chilena de Cirugía Bariátrica y Metabólica, Santiago, Chile
OBJECTIVES: In 2022, Chile's public health insurer implemented a Bundled Payment (PAD) system for cost-sharing between the insurer and patients (co-payment) for bariatric surgeries for eligible patients. Although the payment mechanism is available nationwide, Chile's centralized healthcare system does not align service availability supply with demand. The study aims to assess the implementation of the Bariatric Surgery PAD Program from a geographic equity perspective.
METHODS: A descriptive, retrospective, longitudinal study based on open, anonymized, georeferenced secondary data on hospital discharges for the period 2022-2023.
RESULTS: The Metropolitan Region (Central) accounts for 53.3% of the total activity over the two-year implementation period. This is even though the region comprises only 36.4% of the FONASA beneficiary population. The Bío-Bío Region (Central) follows with 10.2% of activity and 9.0% of beneficiaries, and Valparaíso (North) ranks third with 7.6% of surgeries and 4.2% of beneficiaries. These three regions account for 71.1% of surgical activity but represent only 56.2% of FONASA beneficiaries. In contrast, the highest obesity prevalence rates, adjusted by region, are reported in the southern regions of Aysén (44.3%), Los Ríos (43.8%), and Araucanía (41.1%). However, PAD surgeries in southern Chile comprise only 10.8% of all national bariatric surgeries. Aysén accounts for 0,1% of executed surgeries, Los Ríos 0,2%, and Araucanía 2,7%.
CONCLUSIONS: There is a disparity between obesity prevalence in southern Chile and the number of surgeries performed. Results highlight the need for strategies to improve the regional reach of the PAD program and resource de-centralization.
METHODS: A descriptive, retrospective, longitudinal study based on open, anonymized, georeferenced secondary data on hospital discharges for the period 2022-2023.
RESULTS: The Metropolitan Region (Central) accounts for 53.3% of the total activity over the two-year implementation period. This is even though the region comprises only 36.4% of the FONASA beneficiary population. The Bío-Bío Region (Central) follows with 10.2% of activity and 9.0% of beneficiaries, and Valparaíso (North) ranks third with 7.6% of surgeries and 4.2% of beneficiaries. These three regions account for 71.1% of surgical activity but represent only 56.2% of FONASA beneficiaries. In contrast, the highest obesity prevalence rates, adjusted by region, are reported in the southern regions of Aysén (44.3%), Los Ríos (43.8%), and Araucanía (41.1%). However, PAD surgeries in southern Chile comprise only 10.8% of all national bariatric surgeries. Aysén accounts for 0,1% of executed surgeries, Los Ríos 0,2%, and Araucanía 2,7%.
CONCLUSIONS: There is a disparity between obesity prevalence in southern Chile and the number of surgeries performed. Results highlight the need for strategies to improve the regional reach of the PAD program and resource de-centralization.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD99
Topic
Health Service Delivery & Process of Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)