Article type
Abstract
Background: Health insurance plays an important role in health access, and prevents economic catastrophic shocks to patients who need to undergo expensive treatment for various diseases. The elderly population are at higher risk of illness, and are economically vulnerable.
Objectives: To describe the pattern of insurance coverage among elderly patients undergoing cataract surgery in a multi-tier eye care network in India.
Methods: Electronic medical records of 38,387 patients aged >70 years who underwent cataract surgery between 2011-2022 were assessed. Data was mined to identify the elderly patients undergoing cataract surgery, categorizing their mode of payment into government or private-based insurance utilization.
Results: Private insurance coverage declined steadily from 13.4% at 70 years to 3.9% at 90 years, while government insurance declined from 4.5% at 70 years to 3.9% at 90 years. Prevalence of insurance coverage from 2011-2017 was 10.65% in patients above the age of 70 years. Patients from urban areas had a higher coverage of insurance compared to rural areas. In contrast, the subsequent period of 2018-2022 witnessed a higher insurance coverage of 20.61%. Males had approximately twice coverage rate compared to females. In patients above the age of 85 years, less patients attained vision better than 20/60 when operated without insurance (39%) compared with patients with insurance (48%). Patients covered by government insurance waited a median of 18 days surgery-advice date and surgery, whereas those with private insurance had a waiting time of 11 days.
Conclusion: Insurance coverage for cataract surgery is very low among the elderly, and falls below 10% after 80 years of age. Private insurance coverage falls steeply after 70 years of age. Lack of insurance is associated with poorer visual outcomes after cataract surgery. Government intervention needs to be improved for this vulnerable older population segment.
Objectives: To describe the pattern of insurance coverage among elderly patients undergoing cataract surgery in a multi-tier eye care network in India.
Methods: Electronic medical records of 38,387 patients aged >70 years who underwent cataract surgery between 2011-2022 were assessed. Data was mined to identify the elderly patients undergoing cataract surgery, categorizing their mode of payment into government or private-based insurance utilization.
Results: Private insurance coverage declined steadily from 13.4% at 70 years to 3.9% at 90 years, while government insurance declined from 4.5% at 70 years to 3.9% at 90 years. Prevalence of insurance coverage from 2011-2017 was 10.65% in patients above the age of 70 years. Patients from urban areas had a higher coverage of insurance compared to rural areas. In contrast, the subsequent period of 2018-2022 witnessed a higher insurance coverage of 20.61%. Males had approximately twice coverage rate compared to females. In patients above the age of 85 years, less patients attained vision better than 20/60 when operated without insurance (39%) compared with patients with insurance (48%). Patients covered by government insurance waited a median of 18 days surgery-advice date and surgery, whereas those with private insurance had a waiting time of 11 days.
Conclusion: Insurance coverage for cataract surgery is very low among the elderly, and falls below 10% after 80 years of age. Private insurance coverage falls steeply after 70 years of age. Lack of insurance is associated with poorer visual outcomes after cataract surgery. Government intervention needs to be improved for this vulnerable older population segment.