title: [The way from cost approval to bariatric surgery : Analysis of resource utilization in a maximum care hospital].
abstract: BACKGROUND
  Morbid obesity is a medical and economic challenge. Patients who have the indications for bariatric surgery face a long way from the first visit until surgery and a high utilization of resources is required.
  
  
  OBJECTIVE
  The present study aimed to evaluate labor costs and labor time required to supervise obese patients from their first visit until preparation of a bariatric report to ask for cost acceptance of bariatric surgery from their health insurance. In addition, the reasons for not receiving bariatric surgery after receiving cost acceptance from the health insurance were evaluated.
  
  
  METHODS
  Patients who had indications for bariatric surgery according to the S3 guidelines between 2012 and 2013, were evaluated regarding labor costs and labor time of the process from the first visit until receiving cost acceptance from their health insurance. Furthermore, body mass index (BMI), age, sex, Edmonton Obesity Staging System (EOSS) stage and comorbidities were evaluated. Patients who had not received surgery up to December 2015 were contacted via telephone to ask for the reasons.
  
  
  RESULTS
  In the present study 176 patients were evaluated (110 females, 62.5%). Until preparation of a bariatric report the patients required an average of 2.7 combined visits in the department of surgery with the department of nutrition, 1.7 visits in the department of psychosomatic medicine, 1.5 separate visits in the department of nutrition and 1.4 visits in the department of internal medicine. Average labor costs from the first visit until the bariatric survey were 404.90 ± 117.00 euros and 130 out of 176 bariatric reports were accepted by the health insurance (73.8%). For another 40 patients a second bariatric survey was made and 20 of these (50%) were accepted, which results in a total acceptance rate of 85.2% (150 out of 176). After a mean follow-up of 2.8 ± 1.1 years only 93 out of 176 patients had received bariatric surgery (53.8%). Of these 16 had received acceptance of surgery by their health insurance only after a second bariatric survey.
  
  
  CONCLUSIONS
  A large amount of labor and financial resources are required for treatment of obese patients from first presentation up to bariatric surgery. The cost-benefit calculation of an obesity center needs to include that approximately one half of the patients do not receive surgery within more than 2.5 years.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Nickel
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Tapking
authors.affiliation: Klinik für Endokrinologie, Stoffwechsel und klinische Chemie, Universität Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
authors.forename: U
authors.initials: U
authors.lastname: Zech
authors.affiliation: Klinik für Allgemeine Innere Medizin und Psychosomatik, Universität Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Huennemeyer
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: A T
authors.initials: AT
authors.lastname: Billeter
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: P C
authors.initials: PC
authors.lastname: Müller
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: H G
authors.initials: HG
authors.lastname: Kenngott
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: B P
authors.initials: BP
authors.lastname: Müller-Stich
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. Lars.Fischer@med.uni-heidelberg.de.
authors.forename: L
authors.initials: L
authors.lastname: Fischer
mesh_terms: D000328:Adult; D000367:Age Factors; D050110:Bariatric Surgery / Q000191:economics*; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007344:Insurance Claim Reporting / Q000191:economics; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D009767:Obesity, Morbid / Q000145:classification; D012737:Sex Factors; D012985:Software Design; D014600:Utilization Review
keywords: Bariatric surgery; Health expenditures; Health insurance; Metabolic surgery