Page 169 - When surgery alone won’t cut it - Valerie Maureen Monpellier
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This pilot should be conducted in 2-3 plastic surgical clinics that work closely with a bariatric team. This ensures all information regarding bariatric surgery and weight loss is available. To improve future implementation, the pilot should be developed in collaboration with the Healthinstitute of the Netherlands and insurance companies.
COMMUNICATION
An important part of improving care for the post-bariatric patients (with excess skin) is education. This thesis showed that there is a large part of the post-bariatric patients who desire BCS and never consult a plastic surgeon. These patients assume that they will not get reimbursement and/or are not aware of the current guidelines. It also seems that most healthcare providers involved in the care for bariatric patients are unaware of the current guidelines and do not routinely assess excess skin. Plastic sur- geons should work together with bariatric teams to start with education of the bariatric teams and patients. In addition, general practitioners of the bariatric patients should also be educated. A good start would be a folder with general information about the current rules for reimbursement by the Dutch Society of Plastic and Reconstructive Surgery. In this folder, the general qualifications for reimbursement can be outlined, along with the current definitions for mutilation and impairment of bodily dysfunction. These folders should be readily available in bariatric clinics throughout the country.
FUTURE RESEARCH
As discussed above, it is not possible to increase spending on body contouring sur- gery and optimal patient selection for BCS is key. Ideally patients who will benefit most and have the lowest complications rated should be selected. Benefits in terms of healthcare costs should be included in this model. Although body contouring pro- cedures are considered to be costly, it is unknown how many post-bariatric patients undergo BCS and what the costs of BCS in the Netherlands are. A future study should assess how many patients in the Netherlands currently undergo BCS, how often these patients will develop complications and what the costs of these procedures are. These costs can subsequently be compared to healthcare costs for post-bariatric patients who do not undergo BCS. This will allow assessment of the influence of BCS on long-term healthcare costs. More in-depth analysis will also show which patients will benefit the most.
In addition, Dutch law states the psychological complaints can never be a reason for reimbursement of plastic surgery. However, in evaluation of healthcare treatments HRQoL is currently considered one of the most important outcome parameters. Fu- ture research should also focus on if and how HRQoL should be part of reimburse- ment criteria.
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