Prioritization and willingness to pay for bariatric surgery: the patient perspective.
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 ± 9.9 years, 76% were women, and the mean body mass index was 47.3 ± SD 7.6. The mean wait for surgery was 34.4 ± 9.4 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.


CONCLUSIONS
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.
The Department of Surgery and Center for the Advancement of Minimally Invasive Surgery (CAMIS), University of Alberta, Royal Alexandra Hospital, Edmonton, Alta.
Richdeep S
RS
Gill
The Department of Medicine, University of Alberta, Edmonton, Alta.
Sumit R
SR
Majumdar
The Department of Medicine, University of Alberta, Edmonton, Alta.
Xiaoming
X
Wang
The Department of Medicine, University of Alberta, Edmonton, Alta.
Rebecca
R
Tuepah
The Department of Medicine, University of Alberta, Edmonton, Alta.
Scott W
SW
Klarenbach
The Department of Surgery and Center for the Advancement of Minimally Invasive Surgery (CAMIS), University of Alberta, Royal Alexandra Hospital, Edmonton, Alta.
Daniel W
DW
Birch
The Department of Surgery and Center for the Advancement of Minimally Invasive Surgery (CAMIS), University of Alberta, Royal Alexandra Hospital, Edmonton, Alta.
Shahzeer
S
Karmali
The Department of Medicine, University of Alberta, Edmonton, Alta.
Arya M
AM
Sharma
The Department of Medicine, University of Alberta, Edmonton, Alta.
Raj S
RS
Padwal
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D001294:Attitude to Health; D050110:Bariatric Surgery; D005260:Female; D015276:Health Care Rationing; D019538:Health Care Surveys; D006292:Health Priorities; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000601:surgery*; D014850:Waiting Lists; D055815:Young Adult