Background: In Chile, 3.2% of the population suffers from morbid obesity. Currently, this condition and bariatric surgery are not prioritized by public insurance. The reform of the financing system through Diagnosis-Related Groups (DRG) derived into different financial effects observed in public providers due to reimbursement, and costing issues, leading to unequal access to bariatric surgery.

Objectives: Compare DRG reimbursement and direct costs of bariatric surgery between two Chilean public providers (A and B). Provider A corresponds to a high-complexity regional provider and B to a metropolitan high-complexity provider.

Methods: Two public providers’ open access DRG databases were explored. The data was analyzed by: reimbursement, DRG weight, base price, case-mix, and risk per provider for the same IR-DRG, ICD-9, and ICD-10 codes. Direct costs were estimated using a combined activity-based costing and bottom-up strategy considering: preoperative and follow-up care and surgery.

Results: For provider A, the average DRG reimbursement per bariatric surgery was CLP 4,387,825 at a direct comprehensive care cost of CLP 2,850,975. The average DRG weight was 1,5751, and the base price was CLP 2,814,272 per discharge (88.90% of cases in moderate severity). The gap between direct costs and reimbursement was -35.02%. For Provider B, the average DRG reimbursement per discharge associated with bariatric surgery was CLP 2,932,474 at a direct cost of CLP 3,797,915. The average DRG weight was 1,5106 (75.00% of cases in moderate severity), and the base price was CLP 1,941,168 per discharge. The gap between direct costs and reimbursement was 29.51%. The reimbursement and direct cost difference between providers A and B was CLP 1,455,351 and CLP 946,940 respectively.

Conclusions: Gaps between costs and DRG reimbursement were observed for each provider in bariatric surgery, and incentives differ between them. There is an urgent need to conduct local cost-studies to improve DRG weights and payments.