Patients without private health insurance - a significant social inequality currently exists for Australians from lower socio-economic groups accessing bariatric surgery. Currently, approximately 90% of bariatric surgery procedures are performed in the private sector and patients without private health insurance are denied access to bariatric surgery unless they self fund the procedure (Figure 6).
This has a disportionate impact on Australians from lower socio-economic groups since the prevalence of obesity is higher in lower socio-economic groups who have the greatest clinical need and are less likely to have private health insurance (a survey conducted by ABS found 28% of persons living in the most socio-economically disadvantaged areas had private health insurance compared with 72% of those living in the least socioeconomically disadvantaged areas ).
Figure 6. Bariatric surgery in public and private hospitals during 1999-00 and 2007-08
Data based on DRG K04Z (Major procedures for obesity). NB: DRG, diagnosis-related group.
Source: DOHA, 2008.
Post-surgical follow-up programs - optimal outcome for bariatric surgery patients is achieved through good post-operative care. All current clinical guidelines indicate that bariatric patients should be regularly evaluated after surgery. Table 7 shows an example of a post-surgical care, which includes at least 12 months access to multi-disciplinary care team comprising of experienced bariatric surgeon, psychologists, physiotherapy and dietitians. Currently in Australia, there is no standardised post-surgical follow-up program. Furthermore, follow-up programs are not offered to patients without private health insurance.
Table 7. Example of a gastric band 12 months surgical follow-up program
Source: Prof. Hamdorf, Dr T Brancatisano and Dr R Brancatisano Australian Institute of Weight Control. 2010.