Page 164 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Valorisation Addendum
was related to depressive symptoms. This is comparable to the obese (pre-bariatric) population 15, 16. And in the patients who desired BCS, there was a close relationship between body weight, negative affect and body image. This might be the reason why patients who undergo BCS have better weight loss maintenance.
Weight regain has a negative effect on comorbidities and HRQoL10-12. In part of the patients who develop weight regain, a secondary or tertiary bariatric procedure will be performed 8, 17-19. The re-emerging of comorbidities as well as the secondary or tertiary surgeries have a significant impact on healthcare costs 19.
Thus, excess skin is a serious problem in post-bariatric patients. And the only avail- able treatment, BCS, seems to prolong and improve the results of bariatric surgery by (further) improvement of patient well-being and weight loss maintenance. This can lead to lower healthcare costs. Therefore, BCS should be considered a part of post-bariatric care and efforts should be made to reimburse BCS accordingly. With this valorization addendum, we propose the first steps to improve the reimbursement system for post-bariatric body contouring surgery in the Netherlands.
CURRENT CRITERIA FOR REIMBURSEMENT
The current criteria for reimbursement are partly based on Dutch law. This law states that plastic surgery should not be reimbursed unless there is:
• a congenital deformity: deformity which has been present since birth, or
• a grave disfigurement caused by accident, disease or medical treatment (muti-
lation), or
• a serious impairment of bodily function in daily life 20.
For post-bariatric patients there are additional criteria to qualify for reimbursement: the patient has a) undergone the bariatric procedure more than 18 months before, b) a stable weight for more than 12 months and c) a body mass index (BMI) below 35 kg/m2.
Each post-bariatric patient who desires BCS can ask her/his general practitioner or bariatric surgeon for a referral to the plastic surgeon. The plastic surgeon then decides whether the patient qualifies according to the above criteria and sends all necessary information to the insurance company (through a standardized system). The insur- ance company reviews the information and sometimes requests additional informa- tion such as photographs. Based on this information, the insurance company then decides whether a patient qualifies for reimbursement. This decision overrules the decision of the plastic surgeon. For example, if the plastic surgeon concludes there is a serious impairment of bodily function, but the insurance company does not agree, the patient will not get reimbursed.
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