Recently, I blogged about our observation that even in a publicly funded health care system, lower income patients are less likely to receive bariatric surgery than folks with higher income.
A new study by Thomas von Lengerke and colleagues from the University of Hannover, Germany, published in Psychosomatic Medicine, looks at the impact of socioeconomic status (SES) on direct medical costs for severe obesity in Germany (which has a mixed private and public insurance based health care system).
The researchers compared the costs of severe obesity among German adults in a subsample (N=947) of the KORA-Survey S4 1999/2001 (a cross-sectional health survey in the Augsburg region, Germany; age group: 25-74 years). Data included visits to physicians, inpatient days in hospital, and received and purchased medication. Body mass index was measured and SES was determined via reports of education, income, and occupational status from computer-assisted personal interviews.
In contrast to what the researchers expected (given the propensity for lower-SES patients to be heavier and have more medical problems), the excess costs of severe obesity were substantially (almost three-fold) higher in respondents with high SES (plus euro 2,966 vs. plus euro 1,012).
The differences were even greater after adjustment for the Physical Functional Comorbidity Index (PFCI), with severe obesity’s excess costs being euro 2,406 in the high SES-Index group versus only euro 539 in the lower status group.
This study confirms our findings (using the example of bariatric surgery) that despite similar or greater obesity burden, lower SES patients are less likely to incur direct health costs related to severe obesity.
Several factors may explain these findings:
1) Poorer patients may be less likely to recognize severe obesity as a medical condition that requires medical and/or surgical treatment.
2) Health services may be less accessible to lower SES patients for monetary reasons such as transportation to doctor/clinics, parking, taking time off work, etc.
3) Lower SES patients may be more prone to weight-bias and discrimination thereby making them less likely to seek out and insist on receiving the same level of health care as better-off patients.
Whatever the reasons, it appears that social inequality in access to obesity treatments and equitable allocation of health care resources across the SES continuum is an issue that is not just limited to Canada.
I’d love to hear what my readers think are the likely causes of this disparity and any suggestions that may help address this important issue.
AMS
Edmonton, Alberta
p.s. Join my new Facebook page for more posts and links on obesity prevention and management
von Lengerke T, John J, Mielck A, & KORA Study Group (2010). Excess direct medical costs of severe obesity by socioeconomic status in German adults. Psycho-social medicine, 7 PMID: 20421952
In The News
April 29th, 2010 at 8:42 am
Agree that it’s a combination of factors. People with lower incomes can have higher priorities/stressors than thinking about undergoing a time intensive treatment for their physical health. The expectations of changing diet, exercising etc that is expected in order to qualify for treatment may mean that lower income clients are less likely to meet the targets. Getting to and from all those appointments as you mentioned does take money. Also wealthier people are more likely to access information about bariatric surgery via internet etc, and I would expect that personal research is often the first step for many.
May 3rd, 2010 at 12:43 pm
I’m with CLS. The cause of this disparity is, in my opinion, probably a different take on your first potential reason for it: Poorer patients are less likely to care about obesity in the grand scheme of things in their lives. If a person makes very little money per hour they may have less leisure time than someone that makes more per hour. Less leisure time (that is, time not working as opposed to time spent doing fun things) means less time to do all the other things people do, one of which is getting surgery. If a person of low SES looks around them and sees obese peers, then maybe spending on surgery seems excessive as obesity is “just something that happens.”