Bariatric surgery and the financial reimbursement cycle.
Financial reimbursement for new health care services tends to progress through a predictable cycle. Initially, requests for payment are often honored in full based on the assumption that generous reimbursement is necessary to bring about an expansion of supply, and that pioneering providers have incurred losses while the technology was developed and disseminated. As total third-party payments escalate, concerns regarding the relationship between costs and price are pushed to the fore. Allegations of profiteering, overuse, and abuse spread. These concerns often lead to a set of externally imposed restrictions on payment, with limits placed first on prices, and then usually on quantities and/or aggregate totals as well. In this article, we examine how one new technology, bariatric surgery, is progressing through the reimbursement cycle. Key words: bariatric surgery, obesity, reimbursement.
Schoenthal
Anna R
AR
Health Strategies & Solutions, Inc., Philadelphia, PA, USA.
Getzen
Thomas E
TE
D049088:Bariatrics; D006801:Humans; D008389:Marketing of Health Services; D009765:Obesity / Q000191:economics* / Q000601:surgery*; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D013503:Surgery Department, Hospital / Q000191:economics / Q000458:organization & administration; D013514:Surgical Procedures, Operative / Q000191:economics*; D014481:United States