Go to content

People of lower socioeconomic status less likely to receive cataract surgery in private clinics, study finds

Share

Toronto, ON, August 26, 2024 — Following an infusion of public funding to for-profit surgical centres, the cataract surgery rate fell by 9% for people in the lowest socioeconomic group in these centres, according to new research from ICES, Queen’s University and University of Toronto’s Temerty Faculty of Medicine.

In contrast, researchers found that the rate of cataract surgery for patients in the highest socioeconomic status group rose by 22% at private for-profit centres. Cataract surgery rates fell equally for all patient groups in publicly funded hospitals over the six-year study period.

The COVID-19 pandemic led to large shortfalls in cataract surgery rates worldwide. To meet the growing need in Ontario, public funding was funneled into private, for-profit surgical centres to offset the need to charge patients for extra services.

“It is important to be innovative and open-minded in searching for the best approach to health care,” says lead author Dr. Robert Campbell, a clinician-scientist in the Department of Ophthalmology at Queen’s University and a senior adjunct scientist at ICES.

“However, despite an infusion of public funding into private for-profit surgical centres that was designed to cover facility overhead costs and enable access to care regardless of ability to pay, rates of cataract surgery at private for-profit centres has improved mainly for those with the highest socioeconomic status.”

Published in CMAJ, the researchers analyzed all cataract surgeries (935,729) in Ontario, Canada, between 2017 and 2022, and explored the effect of socioeconomic status on access to surgery at public hospitals versus private for-profit surgical centres. They looked at two time periods: the pre-funding change period up to February 2020, and the post-funding period from March 2020 to March 2022.

Key findings include:

  • 81% of cataract operations were performed in public hospitals, versus 19% performed in private for-profit surgical centres.
  • Patients in the highest socioeconomic category made up 23% of private surgical cases, whereas those in the lower category made up just 14%.
  • Cataract operations performed in private for-profit centres increased from 16% in the pre-COVID period to 23% in the post-funding change period.
  • The private centre surgical rate rose 22% for patients in the highest socioeconomic status group, whereas the rate fell by 9% for patients in the lowest socioeconomic status group.

“If public funding is going to continue to be used to buy services at private for-profit centres, important issues will need to be addressed,” says Campbell. “Patients need to be assured that their interests are the only ones considered in decision making, and that the private centres and the surgeons working there don’t have financial conflicts of interest that could influence the approach to surgery.”

The researchers note that important questions remain unanswered, and that future studies should explore whether patients of lower socioeconomic status decline surgery at for-profit centres because of financial barriers and whether the existence of separate waitlists for those willing to pay plays a role in the disparities.

“Unifying surgical waitlists such that wait times are the same whether a patient pays extra or not would go a long way toward building a fair system,” says Campbell.

The journal article, “Impact of expanding private for-profit cataract surgery on lower socioeconomic status patients: an Ontario population-based study,” was published in CMAJ.

ICES is an independent, not-for-profit research and analytics institute that uses population-based health information to produce knowledge on a broad range of healthcare issues, leading cutting-edge studies and analyses evaluating healthcare policy, delivery, and population outcomes. ICES knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about healthcare delivery and to develop policy. For the latest ICES news, visit our website www.ices.on.ca and follow us on X, formerly Twitter: @ICESOntario

About Queen’s University
Queen’s University has a long history of scholarship, discovery, and innovation that shapes our collective knowledge and helps address some of the world’s most pressing concerns. Home to more than 25,000 students, Queen’s offers a comprehensive research-intensive environment. Diverse perspectives and a wealth of experience enrich our students and faculty while a core part of our mission is to engage in international learning and research.

In 2023, for the third year in a row, Queen’s University has ranked in top 10 globally Times Higher Education Impact Rankings, securing the position of third worldwide and first in North America. The rankings measured over 1,700 post-secondary institutions on their work to advance the United Nations’ Sustainable Development Goals (SDGs).

Founded in 1827, the University of Toronto is Canada’s top university with a long history of challenging the impossible and transforming society through the ingenuity and resolve of its faculty, alumni and supporters. We are proud to be one of the world’s top research-intensive universities, bringing together top mins from every conceivable background and discipline to collaborate on the world’s most pressing challenges.

Our community is a catalyst for discovery, innovation and progress, creating knowledge and solutions that make a tangible difference around the globe. And we prepare our students for success through an outstanding global education rooted in excellence, inclusion and close-knit learning communities.

The ideas, innovations and contributions of more than 679,00 graduates advance U of T’s impact on communities across the globe. Together, we continue to defy gravity by taking on what might seem unattainable today and generating the ideas and talent needed to build a more equitable, sustainable and prosperous future.

FOR FURTHER INFORMATION PLEASE CONTACT:  

Misty Pratt
Senior Communications Associate, ICES
[email protected] 613-882-7065

Read the Journal Article