OBESE people on low incomes are getting far less access to weight-loss surgery than people on high incomes with private health insurance, new research shows.
The finding has prompted doctors to call for more government-funded surgery as people in lower socio-economic groups are more likely to be severely obese, increasing their risk of diabetes, heart disease and premature death.
A study published in The Medical Journal of Australia on Monday found that the more money you earned, the more likely you were to access bariatric surgery including adjustable gastric banding, stomach stapling and gastric bypass.
The trend was so stark that people on a household income of more than $70,000 were five times more likely to get the procedures than people earning less than $20,000.
Researchers used data from the Sax Institute's 45 and Up Study to analyse who was accessing bariatric surgery and where. They found that while 312 out of 49,000 people in the study had had one of the procedures, only one person had the surgery done in a public hospital and three were treated under Department of Veterans' Affairs entitlements. The remaining 308 were operated on in private hospitals.
Dr Rosemary Korda, an author of the report from Australian National University, said the trend largely reflected systemic issues in Australia's health system, which led to inequities.
For example, she said while bariatric surgery had been listed on the Medicare Benefits Schedule for 20 years in recognition of its cost-effectiveness, many public hospitals that were mostly funded by the states did not offer the procedures.
This meant people were being sent into the private system where it costs more than $12,000 without private health insurance. While Medicare provides about $800 to fund the procedure in private hospitals, those with private health insurance will generally face more than $4000 in out-of-pocket costs.
''Our findings suggest that bariatric surgery, an MBS-listed procedure, is currently largely available only to those who can afford private health insurance and the associated out-of-pocket costs, with poor access to these cost-effective procedures in the section of the population that needs it most,'' she wrote in the journal.
Dr Korda urged governments to consider ways of funding more surgery because research showed it caused substantial weight loss, leading to improvements in cholesterol, sleep apnoea and joint problems associated with obesity.
It could also treat type 2 diabetes, with one trial showing remission rates of 75 to 95 per cent within two years of surgery. About 1.5 million Australians are estimated to have type 2 diabetes, costing the nation about $12 billion each year.
The president of the Australian Medical Association Victoria, Dr Stephen Parnis, said although doctors last year called for the state government to fund more bariatric surgery for people with severe obesity, this had not happened to date.