EFFECTS OF INSURANCE COVERAGE ON CATARACT SURGERY
[Problems/question addressed] Utilization of elective surgery is heavily influenced by the extent to which it is covered by health insurance. The typical example would be cataract surgery. Cataract@is mainly caused by aging and the surgery is indicated to improve QOL rather than life saving purpose. Cataract surgery fee has been fully covered by national health insurance in Japan, however exclusion of@IOL (intraocular lens) from health insurance benefit has been a major financial obstacle for the elderly@to seek the surgery. In response to public demand, IOL was included in the health insurance benefit@in April 1992. In this presentation the author attempts to asses the effect of inclusion of IOL on utilization and cost of cataract surgery for the elderly.
[Data and methods] Utilization and cost data were extrapolated from Social Insurance Claims Survey, a nationwide sampling survey on monthly health insurance claims submitted to insurers in June (i.e.for the services rendered in May) which is conducted by Ministry of Health & Welfare every year. The estimated number of cataract surgery was matched with the number of beneficiaries aged 70 or over in the corresponding month to compute the annual utilization per 1,000 beneficiaries. Data before '86 were not used because of limitation of comparability.
[Results and conclusions]The utilization of cataract surgery per 1,000 beneficiaries has steadily increased from 11.0 eyes in '86 to 25.4 eyes in '93. Although it showed a decline in '91 and a rebound in the following year, the baseline shown in [figure] as dotted line appears consistent and returned to the projected level in '93. It can be inferred that approximately 17–18% of the surgery was deferred in '91 in anticipation of the forthcoming inclusion of IOL to insurance benefit in the following year.
[Implications of findings] The inclusion of IOL to health insurance benefit motivated the elderly to defer the surgery until the benefit is available, however it did not appear to have affected the natural course of projected increase of the surgery.
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