Bariatric surgery, insurance, and the hidden cost of saving lives

For people living with severe obesity, bariatric surgery is not about appearances. It is often a matter of survival. Procedures such as gastric sleeve or bypass surgery can reduce diabetes, improve heart health, and extend life expectancy. They are widely recognized as the most effective long-term treatments for obesity. Given the stakes, you might expect that surgeons performing these operations would be strongly supported. Instead, a new study published in the [ANZ Journal of Surgery] reveals a troubling reality. Bariatric surgeons across Australia are being forced out of practice, not because of surgical complications or lack of demand, but because of the skyrocketing cost of **professional indemnity insurance (PII)**. If this continues, the consequences will fall hardest on the patients who need surgery the most. ### Professional indemnity insurance Professional indemnity insurance is mandatory for doctors in Australia. It protects them in case a patient sues for malpractice. In practice, it functions like car insurance, but with far higher stakes and far higher premiums. Without it, a surgeon cannot legally operate. The **Australian and New Zealand Metabolic and Obesity Surgical Society (ANZMOSS)** surveyed 222 bariatric surgeons across the country to understand the financial burden. More than half responded, and their answers highlight just how severe the problem has become. In the 2022–23 financial year, bariatric surgeons reported average premiums of **$51,748**. In 2023–24, that average soared to nearly **$70,000**, a 35 percent increase in just one year. Some surgeons reported paying as much as **half a million dollars annually** just to stay insured. Despite this enormous cost, malpractice cases rarely reach trial. Out of 142 claims recorded in the survey, only three went to trial, and none resulted in a judgment against the surgeon. The gap between the rarity of successful claims and the price of coverage is astonishing. The rise of **“no win, no fee”** legal practices has encouraged more malpractice claims, including those without strong evidence. For insurers, it is often cheaper to settle than to contest a case in court, even if the surgeon acted appropriately. This cycle drives premiums higher. Another problem lies in the use of “expert witnesses.” In many cases, bariatric surgeons are judged by specialists from unrelated fields. It is akin to having a heart surgeon’s work evaluated by someone who has never performed heart surgery. In response, ANZMOSS has created an **Independent Medicolegal Advisory Panel** of qualified experts to provide accurate testimony. Even so, the system remains stacked against surgeons, and costs continue to rise. ### When insurance costs close clinic doors The survey results carry serious implications for patient care. About **3 percent of bariatric surgeons have already stopped operating because of insurance costs**, and another **37 percent are considering leaving the field**. That means nearly four out of ten surgeons may no longer be available, not by choice, but because they cannot afford to remain insured. The situation is even worse in rural areas. Surgeons in regional communities often face higher premiums, yet their patients already have fewer options for specialist care. If rural clinics close, many people will be left without realistic access to treatment. Self-funded patients are also affected. Many pay tens of thousands of dollars out of pocket, often dipping into savings or retirement funds. Because of the high costs, they are more likely to sue if the outcome falls short of expectations, which insurers consider additional risk. That risk, in turn, drives premiums even higher. It is tempting to see this as a professional problem limited to surgeons. However, obesity is among Australia’s most urgent health issues. The **Australian Institute of Health and Welfare** reports that two-thirds of adults and one-quarter of children are overweight or obese. For those at the severe end, bariatric surgery is often the only effective long-term treatment. If surgeons are priced out of practice, patients will face longer waits, higher costs, or no access at all. The result will be more diabetes, more heart disease, and more preventable deaths. The authors of the study propose several reforms to help stabilize the system. They suggest changes to tort law, including caps on damages and limits on contingency fees, to reduce incentives for weak lawsuits. They recommend creating a national registry of malpractice claims to track patterns and improve safety. They argue that only qualified bariatric experts should testify in malpractice cases. They also call for expanded government support through programs like the Premium Support Scheme, which subsidizes insurance costs when they exceed a set percentage of income. These measures may not solve the problem overnight, but they could keep more surgeons in practice, and more patients alive. Patients must have the right to pursue justice if harmed by negligence. At the same time, a system that forces skilled surgeons out of practice even when they are not at fault is deeply flawed. Bariatric surgery is not a luxury procedure. For many Australians, it represents the leap between decades of chronic illness and a chance at a healthier future. Allowing soaring insurance costs to shut clinic doors means the price will not only be financial, but also measured in lives lost. If you want to learn more, read the original article titled "Professional indemnity insurance rates for metabolic bariatric surgeons in Australia: survey results" on [ANZ Journal of Surgery] at . [ANZ Journal of Surgery]: http://dx.doi.org/10.1111/ans.70087

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