Surgeons’ and payers’ perceptions of barriers to accessing bariatric and metabolic surgery in Argentina: An exploratory qualitative study

Introduction Bariatric and metabolic surgery is a safe and effective method for treating clinically severe obesity. In Argentina, Law 26 396 and its amendments establish the regulatory framework for its coverage. However, administrative, regulatory, and financial barriers limit effective access to it, with gaps remaining in its scope and understanding. This study aimed to explore surgeons' and health insurance providers' perceptions of the implementation of bariatric and metabolic surgery in Argentina, within the framework of Law 26 396, and to identify the barriers that impede effective, timely access. Methods We conducted an exploratory qualitative study comprising 16 in-depth virtual interviews with eight surgeons specializing in bariatric and metabolic surgery and eight health insurance officers of the Argentine healthcare system, conducted between November and December 2024. The sampling was intentional. The interviews were recorded, transcribed, and coded. A thematic and recursive analysis was conducted, enabling us to identify emerging categories. Results We identified multiple barriers and challenges to the effective implementation of bariatric and metabolic surgery in Argentina, including geographic inequalities, heterogeneity in surgical module agreements, administrative and bureaucratic restrictions related to variability in the interpretation of the law and its requirements, high costs, and the imposition of quotas that delay timely access, among others. Conclusions The implementation of bariatric and metabolic surgery presents structural and functional challenges that affect equitable and timely access. Although Law 26 396 and its subsequent regulations established a regulatory framework for its coverage, tensions among healthcare system actors and regional disparities have resulted in heterogeneous implementation. Administrative and financial barriers persist, affecting its effective and timely practice. We highlight the need to strengthen coordination between physicians and health insurance providers, promoting opportunities for dialogue that optimize authorization and funding processes.