Introduction: The prevalence of obesity reaches 32.3% in women of reproductive age. Obesity is associated with comorbidities that could increase reimbursement needs related to the treatment of these patients during vaginal birth (VB) or cesarean section (CS).

Objective: To estimate additional reimbursement needs associated with VB and CS in Chile patients with and without obesity.

Methodology: Exploration of four public hospital open-access databases Diagnosis Related Groups (DRGs), based on local reimbursement and payment rules (DRG weight, DRG base price per cluster). Reimbursement needs were estimated from the public health insurance perspective (2020 CLP currency). Inpatient data was retrieved for 2018, 2019, and 2020.

Results: From a total of n=39,733 hospital discharges analyzed, 24.97% reported obesity in ICD-10 codes. Of the total records, 75.40% were classified as minor severity (of which 19.32% had an obesity registry), 18.56% moderate severity (25.92% with registered obesity), and 6.05% as greater severity (22.93% registered obesity). Significant differences in severity between subgroups with and without obesity were found (p-value<0.001). Cases with reported obesity showed a higher CS rate (51.60% versus 37.90%) and moderate severity (23.36% versus 16.96%). Cases of VB and CS with reported obesity are 9.18% (CLP 78,896) more expensive on average (14% maximum) than those without obesity. All hospitals report excess days of hospital stay in patients with obesity. For VB, bed days ranged from +0.12 to +0.429, and for CS, from -0.02 to +0.45 days.

Conclusion: It is necessary to increase the accuracy of obesity registration in the Chilean experience due to its role in reflecting additional reimbursement needs. All the transfers explored for VB and CS care were associated with higher average reimbursement needs for women who suffer from obesity, longer days of stay, and greater complexity.