Willingness to Pay for Cataract Surgery Provided by a Senior Surgeon in Urban Southern China.

Mei Wang,Xiaofeng Lin,Yingfeng Zheng,Xianhua Lin,Yunlan Ling,Ecosse Lamoureux,Mingge Li,Yajing Zuo,Chen-Wei Pan

doi:10.1371/journal.pone.0142858

Abstract

PurposeTo study willingness to pay for cataract surgery and surgical service provided by a senior cataract surgeon in urban Southern China.MethodsThis study was a cross-sectional willingness-to-pay (WTP) interview using bidding formats. Two-hundred eleven persons with presenting visual impairment in either eye due to cataract were enrolled at a tertiary eye hospital. Participants underwent a comprehensive eye examination and a WTP interview for both surgery and service provided by a senior surgeon. Demographic information, socioeconomic status and clinical data were recorded.ResultsAmong 211 (98% response rate) persons completing the interview, 53.6% were women and 80.6% were retired. About 72.2% had a monthly income lower than 1000 renminbi (US $161). A total of 189 (89.6%) were willing to pay for cataract and the median amount of WTP was 6000 renminbi (US$968). And 102 (50.7%) were willing to pay additional fees for surgery performed by a senior surgeon, and the median amount of WTP was 500 renminbi (US$81). In regression models adjusting for age and gender, persons with preexisting eye diseases other than cataract, were more likely to pay for cataract surgery and service provided by a senior surgeon (P = 0.04 for both).ConclusionsIn urban China, cataract patients, especially those with preexisting eye conditions, are willing to pay additional fees for a senior surgeon. Moving to a system where the price of cataract surgery is proportional to the consultant’ skill and expertise is possible and may have a potential impact on waiting list and quality of eye care. Further studies are needed to examine the impact of such pricing system on attitudes and choices of cataract patients.

Highlights

Blindness due to cataract is usually curable with an excellent prognosis for sight restoration, many patients with cataract do not receive medical treatment due to a variety of reasons including concerns of cost, fear of surgery, quality of services, transportation, and lack of family support.[1,2,3,4,5] Data from population-based studies show that only 3% of those aged 45 + years in North China,[6] and 4.4% of those aged 50+ in Urban Southern China underwent cataract surgery.[7]
In regression models adjusting for age and gender, persons with preexisting eye diseases other than cataract, were more likely to pay for cataract surgery and service provided by a senior surgeon (P = 0.04 for both)
A recent population-based study shows that the 5-year incidence of cataract surgery in urban Southern China has improved to 4.8% in 2009,[9] probably due to improved health care access after the establishment of basic social medical insurance system (BSMIS)

Summary

Introduction

Blindness due to cataract is usually curable with an excellent prognosis for sight restoration, many patients with cataract do not receive medical treatment due to a variety of reasons including concerns of cost, fear of surgery, quality of services, transportation, and lack of family support.[1,2,3,4,5] Data from population-based studies show that only 3% of those aged 45 + years in North China,[6] and 4.4% of those aged 50+ in Urban Southern China underwent cataract surgery.[7] The World Health Organization (WHO) has set a cataract surgery rate (CSR, cataract operations per million population per year) of 3000 as the minimum necessary to eliminate cataract blindness, but China’s CSR is still lower than 1300.[8]. It is not a surprise to see that china has more than 23,000 ophthalmologists, but on average each doctor treats only approximately 24 cases of cataract per year.[15;16] These data confirm that eye services could have been better allocated between consumers

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Conclusion