Disparity in USA cataract surgery

Medicare patients in the United States are 5.5 times more likely to get cataract surgery than those who receive their care from the Department of Veterans Affairs, according to a study reported in the March 2010 issue of the American Journal of Medical Quality.

This appears to endorse the trend that the frequency of cataract surgery may be responsive to financial incentives to either or both the medical facility and the doctors who conduct the surgery.

“We don't know yet what exactly accounts for the five and a half fold difference in surgery rates between the two systems. It may be related to how the two systems are funded by the government, it could be a difference between physician-driven decisions or it may be related to a lack of ophthalmologists within the VA system or it could be more than one of these factors,” said first author Dustin French, Ph.D., Regenstrief Institute investigator and assistant professor of medicine at the Indiana University School of Medicine. Dr French is a health economist who studies health outcomes.

“The results of our study raise important questions about the possible existence of a two-tier, federally funded health-care system that may not be equivalent in terms of quality of care,” said Dr French, who is also a research scientist with the Centre of Excellence on Implementing Evidence Based Practice at the Richard A. Roudebush VA Medical Centre.

The authors note that their findings provide ample reason to further investigate the determinants of cataract surgery rates. Nationwide, in America, cataract surgery is the most common surgical procedure performed by ophthalmologists.