Providing access to affordable bariatric surgery for uninsured Denver County residents: description of a successful public health initiative

Abstract

Background: Severe obesity disproportionately affects medically underserved communities. However, patients from these communities are the least likely to have access to affordable bariatric surgery. Few studies have described successful initiatives to mitigate this disparity.

Objectives: To describe the implementation of a public health initiative that provided affordable bariatric surgery to uninsured patients at our hospital.

Setting: Denver Health Medical Center (DHMC), a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited safety-net hospital.

Methods: Context regarding Denver city and county, DHMC, and bariatric surgery accreditation are provided, followed by a detailed description of the intervention.

Results: Successful implementation of the initiative centered around: (1) MBSAQIP accreditation; (2) identification of existing institutional charity care programs, (3) enlistment of support/buy-in from key parties; (4) presentation of both general and institutional-specific outcome data following bariatric surgery to hospital administration; (5) framing of the argument as primarily financial, rather than moral; (6) delineation of initial volume and risk expectations; and (7) outcome monitoring.

Conclusion: We successfully provided access to affordable bariatric surgery for uninsured patients at our accredited safety-net hospital.

Keywords: Access; Bariatric surgery; Healthcare disparities; Obesity; Perioperative care.