Prioritization and willingness to pay for bariatric surgery: the patient perspective

• Published in: Canadian Journal of Surgery 2014-02, Vol.57 (1), p.33-39
• Main Authors: Gill, Richdeep S., MD, Majumdar, Sumit R., MD, MPH, Wang, Xiaoming, PhD, Tuepah, Rebecca, BSc, Klarenbach, Scott W., MD, Birch, Daniel W., MD, Karmali, Shahzeer, MD, Sharma, Arya M., MD, Padwal, Raj S., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Alberta; Attitude to Health; Bariatric Surgery; Beliefs, opinions and attitudes; Criteria; Female; Gastrointestinal surgery; Health Care Rationing; Health Care Surveys; Health Priorities; Health Services Accessibility; Health Services Needs and Demand; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Obesity; Obesity - surgery; Patients; Studies; Surgery; Waiting Lists; Young Adult
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.021212

Background Access to publicly funded bariatric surgery is limited, potential candidates face lengthy waits, and no universally accepted prioritization criteria exist. We examined patients’ perspectives regarding prioritization for surgery. Methods We surveyed consecutively recruited patients awaiting bariatric surgery about 9 hypothetical scenarios describing patients waiting for surgery. Respondents were asked to rank the priority of these hypothetical patients on the wait list relative to their own. Scenarios examined variations in age, clinical severity, functional impairment, social dependence and socioeconomic status. Willingness to pay for faster access was assessed using a 5-point ordinal scale and analyzed using multivariable logistic regression. Results The 99 respondents had mean age of 44.7 ± years, 76% were women, and the mean body mass index was 47.3 ± SD 7.6. The mean wait for surgery was 34.4 ± months. Respondents assigned similar priority to hypothetical patients with characteristics identical to theirs ( p = 0.22) and higher priority (greater urgency) to those exhibiting greater clinical severity ( p < 0.001) and functional impairment ( p = 0.003). Lower priority was assigned to patients at the extremes of age ( p = 0.006), on social assistance ( p < 0.001) and of high socioeconomic status ( p < 0.001). Most (85%) respondents disagreed with payment to expedite access, although participants earning more than $80 000/year were less likely to disagree. Conclusion Most patients waiting for bariatric surgery consider greater clinical severity and functional impairments related to obesity to be important prioritization indicators and disagreed with paying for faster access. These findings may help inform future efforts to develop acceptable prioritization strategies for publicly funded bariatric surgery.