Bariatric surgery in Belgium: organisation and payment of care before and after surgery
Authors: Van Den Heede Koen , ten Geuzendam Belinda , Dossche Dorien , Janssens Sabine , Louwagie Peter , Vanderplanken Kirsten , Jonckheer Pascale 
Published: January 2025

SCIENTIFIC REPORT 11 -- 1 INTRODUCTION 11 -- 1.1 EPIDEMIOLOGY OF OVERWEIGHT AND OBESITY 11 -- 1.2 MANAGEMENT OF OBESITY 12 -- 1.2.1 Introduction 12 -- 1.2.2 Effectiveness of bariatric surgery 16 -- 1.3 SCOPE AND RESEARCH OBJECTIVES 18 -- 1.4 KEY POINTS 19 -- 2 BARIATRIC SURGERY IN BELGIUM: ANALYSIS OF THE CURRENT BELGIAN SITUATION 20 -- 2.1 BELGIAN CRITERIA FOR REIMBURSEMENT 20 -- 2.2 EPIDEMIOLOGY OF BARIATRIC SURGERY IN BELGIUM 21 -- 2.2.1 IMA-AIM data 21 -- 2.2.2 Evolution in the number of (first) bariatric surgery procedures 21 -- 2.2.3 Demographic information about bariatric surgery patients 24 -- 2.2.4 Prevalence of bariatric surgery since start nomenclature 24 -- 2.3 ORGANIZATION OF BARIATRIC SURGERY 28 -- 2.3.1 Pre-surgery care 28 -- 2.3.2 Distribution of bariatric surgery patients by hospitals and surgeons 28 -- 2.3.3 Follow-up by Bariatric surgery centres 33 -- 2.3.4 Role of General practitioners 34 -- 2.3.5 Pregnancy after bariatric surgery 44 -- 2.3.6 Accountability patients 45 -- 2.3.7 Registries 45 -- 2.4 KEY POINTS 45 -- 3 A QUALITATIVE ANALYSIS OF PATIENTS AND HEALTHCARE PROFESSIONALS VIEWS 47 -- 3.1 PATIENT VIEWS: BEST-PRACTICES AND UNMET NEEDS 47 -- 3.1.1 Objective 47 -- 3.1.2 Methods: interviews with Belgian patients 47 -- 3.1.3 Description of the patient sample 48 -- 3.1.4 Patients decision for surgery 49 -- 3.1.5 Preparation during the pre-surgery phase 51 -- 3.1.6 Post-operative follow-up 60 -- 3.2 A QUALITATIVE ANALYSIS OF HEALTHCARE PROFESSIONALS VIEWS 84 -- 3.2.1 Objective 84 -- 3.2.2 Methods 84 -- 3.2.3 Description of the nominal groups 85 -- 3.2.4 Results 86 -- 3.3 KEY POINTS 100 -- 4 LITERATURE REVIEW GUIDELINES AND PATHWAYS 104 -- 4.1 OBJECTIVE 104 -- 4.2 METHODS 104 -- 4.3 RESULTS: GENERAL CONSIDERATIONS 105 -- 4.4 PRE-OPERATIVE PERIOD 105 -- 4.4.1 Pre-operative assessment 105 -- 4.4.2 Pre-operative preparation programme 117 -- 4.4.3 Composition of the team and duration of the pre-operative period 121 -- 4.5 DECISION MAKING 122 -- 4.6 POST-OPERATIVE FOLLOW-UP DURING THE FIRST 2 YEARS 125 -- 4.6.1 Post-operative monitoring 125 -- 4.6.2 Post-operative management programme 138 -- 4.6.3 Composition of the team and time points of the post-operative period 155 -- 4.7 LONG TERM FOLLOW-UP 158 -- 4.7.1 Long term follow-up monitoring 160 -- 4.7.2 Long term follow-up management 161 -- 4.8 PREGNANCY 163 -- 4.9 ORGANIZATIONAL LEVEL 165 -- 4.10 KEY POINTS 172 -- 5 INTERNATIONAL DESCRIPTION OF ORGANISATION AND PAYMENT 179 -- 5.1 INTRODUCTION AND STUDY APPROACH 179 -- 5.2 THE NETHERLANDS 180 -- 5.2.1 Criteria for reimbursement bariatric surgery and utilization rates 180 -- 5.2.2 The role of bariatric surgery centres 181 -- 5.2.3 Role of GPs 183 -- 5.2.4 Registry 184 -- 5.2.5 Body contouring surgery 186 -- 5.3 ENGLAND 187 -- 5.3.1 Criteria for reimbursement bariatric surgery and utilization rates 187 -- 5.3.2 The role of (bariatric surgery) centres 189 -- 5.3.3 Role of GPs 190 -- 5.3.4 Registry 191 -- 5.3.5 Body contouring surgery 193 -- 5.4 FRANCE 193 -- 5.4.1 Criteria for reimbursement of bariatric surgery and utilization rates 193 -- 5.4.2 The role of bariatric surgical centres and surgeons 195 -- 5.4.3 Role of GPs 196 -- 5.4.4 Bariatric surgery registry and other relevant databases. 197 -- 5.4.5 Body contouring surgery 197 -- 5.5 SWEDEN 198 -- 5.5.1 Criteria for reimbursement and bariatric surgery utilization rates 198 -- 5.5.2 The role of bariatric surgery centres 199 -- 5.5.3 The role of the GPs 200 -- 5.5.4 Nationwide registry 200 -- 5.5.5 Body contouring surgery 202 -- 5.6 COMPLIANCE FOLLOW-UP CARE 203 -- 5.7 VOLUME-OUTCOME RELATIONSHIP 205 -- 5.8 KEY POINTS 207 -- 6 SOLUTIONS ELEMENTS FOR THE ORGANISATION AND PAYMENT OF THE CARE OF BARIATRIC SURGERY IN BELGIUM 211 -- 6.1 INTRODUCTION 211 -- 6.2 ACCESS TO BARIATRIC SURGERY 213 -- 6.3 BARIATRIC SURGERY CENTRE 215 -- 6.3.1 Multidisciplinary team Bariatric surgery centre 215 -- 6.3.2 Coordinator 217 -- 6.3.3 Volume-thresholds 219 -- 6.3.4 Identify key-interventions for a care pathway 221 -- 6.4 PRIMARY CARE 223 -- 6.5 PATIENT ENGAGEMENT 227 -- 6.6 PAYMENT SYSTEM 232 -- 6.6.1 Payment for consultations with a psychologist and dietician via the convention 232 -- 6.6.2 Conventions 234 -- 6.6.3 Pilot projects 236 -- 6.7 BARIATRIC SURGERY REGISTRY 237 -- REFERENCES 240