Background

Regional differences in healthcare access negatively affects patient outcomes. Despite increased access to metabolic surgery (MS) via Medicaid and Medicare services (CMS), disparities persist. We hypothesize that CMS patients may not travel farther, but travel from higher deprivation areas compared to those privately insured (PI) or self-pay (SP) individuals.

Methods

A total of 1394 records of MS were identified. Duplicate patients, PO boxes, and out-of-state addresses were excluded, and 923 cases were analyzed. Cases were geocoded and matched to the 2021 Area Deprivation Index (ADI, UW-Madison's Neighborhood Atlas). ANOVA with Tukey's post-hoc analyses were applied to assess payer status by distance-to-care and ADI.

Results

Mean state ADI deciles for Medicaid, Medicare, PI, and SP were 5.43, 5.39, 4.32, and 2.93, respectively (p<0.01). Mean national ADI percentiles for Medicaid, Medicare, PI, and SP were 68.4, 68.0, 59.6, and 49.3, respectively (p<0.01). Post-hoc analysis revealed no difference between Medicaid and Medicare ADI (state p=0.99, national p=0.99), or PI and SP (state p=0.21, national p=0.23). Comparisons between CMS-covered and PI/SP groups were significant (p<0.01). No differences in mean travel distances were found for Medicaid (25.27miles), Medicare (19.70miles), PI (22.41miles), and SP (22.13miles) (p=0.23). When adjusted for ADI, however, distance-to-care was increased by payer status (p=0.048); post-hoc comparisons notable for true differences in Medicaid and PI (p=0.04).

Conclusions

Significant socio-economic disparities in MS access to care are evident, marked by ADI score differences despite similar travel distances. Targeted, region-based interventions and policy focused on socio-economic contributors to obesity treatment access are needed.