Increasing funding for private clinics did not improve access to cataract surgery for low-income groups

Despite increased funding for cataract surgery to private, for-profit clinics, access to surgery for low-income people has declined by 9%, according to new research published in . CMAJ ,Canadian Medical Association Journal, https://www.cmaj.ca/lookup/doi/10.1503/cmaj.240414,

Unsurprisingly, despite new public funding for operations at private for-profit surgical centers, which was intended to fully cover all overhead costs and eliminate the need to charge patients, this inequality did not decrease but rather increased during the funding change period,” says.

Dr. Robert Campbell, lead author, physician-scientist, Department of Ophthalmology at Queen's University and Senior Assistant Scientist at ICES

The COVID-19 pandemic caused a backlog of cataract surgery appointments, and the provincial government provided funding to private clinics in 2020 to allow patients to access the surgeries without having to pay.

The study, conducted by researchers from ICES, Queen's University and the University of Toronto, included 935,729 cataract surgeries performed in Ontario between January 2017 and March 2022. The researchers looked at differences in the socioeconomic status of patients who underwent surgery at publicly funded hospitals and those who underwent surgery at private, for-profit centres before the additional funding (until February 2020) and after (March 2020-2022).

Most cataract surgeries (81%) were performed in public hospitals, while the remaining 19% were performed in private, for-profit surgical centers. Over the 6-year study period, more people from the highest socioeconomic class (23%) had surgery in private clinics, while more patients from the lowest income group (14%) had surgery. Surgeries performed in hospitals were evenly distributed across socioeconomic classes. Cataract surgeries in private, for-profit centers increased from 16% in the pre-pandemic period to 23% in the period after the increase in funding. Surgery rates in private, for-profit centers increased by 22% for patients in the highest socioeconomic class, but rates fell by 9% for patients in the lowest socioeconomic group.

To improve access for patients at all socioeconomic levels, policy changes are needed to ensure transparency and reduce conflicts of interest.

“Patient protection requires the elimination of all conflicts of interest among surgeons, including center ownership and incentive schemes aimed at promoting the selling of additional services. Patients also need clear, non-confrontational information about the availability of publicly funded alternatives at no additional charge at both public and private for-profit centers,” the authors write.

They recommend creating a single waiting list for all private surgical clinics and public hospitals in an area, rather than separate lists for public hospitals and for-profit centers.

“Addressing the factors that underlie this inconsistency is critical to ensuring equitable access to surgery and maintaining public confidence in the cataract surgery system.”