1967-P: High-Deductible Plans and Bariatric Surgery Use among Enrollees with Diabetes Living in Disadvantaged Neighborhoods

Introduction and Objective: High Deductible Health Plans (HDHPs) require consumers to cover 100 percent of most healthcare costs up to a certain annual amount—the deductible—at which point their insurance coverage and other cost-sharing arrangements, such as co-pays and co-insurance, begin. High out-of-pocket costs requirements for bariatric surgery may lead enrollees suffering with obesity and obesity-related diseases such as Type 2 Diabetes (T2DM) to delay or forgo bariatric surgery, particularly those living in disadvantaged neighborhoods. Methods: This controlled observational, longitudinal survival analysis used data from a large commercial insurer (2007-2020) to compare bariatric surgery use across members with T2DM residing in disadvantaged neighborhoods, involuntary switched into to HDHPs (deductible ≥ $1,000) to that of their counterparts who remained in Low Deductible Health Plans (LDHPs; deductible <$1,000). The index date was the beginning of the month of the deductible increase for the treatment population and the beginning of the month in which the yearly health insurance contract was renewed for the comparison group. The outcome of interest was “any bariatric surgery” in the post-index period. Cox-proportional hazard modeling was used to conduct this analysis. We conducted analyses for the entire study population and stratified across zip code racial diversity. Results: HDHP exposure was associated with a 63%, 64%, and 58% lower likelihood of undergoing bariatric surgery among all members, members residing in neighborhoods with a higher proportion of white individuals and members residing in a neighborhood with a larger proportion of racially diverse individuals, respectively. Conclusion: This study suggests that HDHPs pose a barrier to bariatric surgery access among members with T2DM residing in low-income neighborhoods, irrespective of the racial composition of the neighborhood. Disclosure K. Narain: None. N. Jackson: None. F. Zhang: Research Support; Current; Pfizer Inc., GlaxoSmithKline plc. D. Ross-Degnan: None. R. LeCates: None. S. Argetsinger: None. O. Duru: Consultant; Current; Boehringer Ingelheim International GmbH. J.F. Wharam: None. Funding National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (1U24DK132746-01)