Preservation and Restoration of Vision:

Vision for the Future, Part 2: Economic Benefits of Ophthalmologic Care: Introduction

In developing countries, a large percentage of the population is poor and does not have health insurance.

Very often government infrastructure is inadequate to provide high-quality, high-volume health care services commensurate with the magnitude of the problem. Increasingly, international and local non-governmental organizations (NGOs), dependent on donations for operating costs, are finding it difficult to obtain financing to maintain operations or expand service delivery.

Developing eye care that is affordable and accessible to the poor, and financially self sustaining from user fees requires careful investigation of the economics of eye care delivery.

Factors to be examined include: understanding the local peoples' capacity to pay, reducing costs, improving efficiency and creating market demand for services through quality improvement and pricing for affordability.

As with any development where the goal is financial sustainability, the objective is to increase volume to lower unit costs and prices while maintaining high quality and affordability.

As with any development where the goal is financial sustainability, the objective is to increase volume to lower unit costs and prices while maintaining high quality and affordability.

Eye care with an emphasis on cataract surgery is one of the few health care services that can become financially self-sustaining from user fees while maintaining an orientation to serving the poor. Cataract accounts for approximately 60% - 80% of blindness and is the primary income generating procedure performed by ophthalmologists worldwide.

In other large-scale public health programs that are prevention oriented, it has been learned through many failures at cost recovery that people are unwilling to pay for prevention.

For other curative services, the expression of the disease and its treatment are more variable from patient to patient as compared to cataract surgery which is the same in each case: costs are the same for each patient and can be made affordable to the poor (as compared to other chronic and acute disease entities which are costly in their treatment and where there is insufficient volume to reduce the unit cost and have economy of scales).

Because of the large number of people requiring cataract surgery in developing countries, it is one of the few secondary care procedures that has the potential for paying for itself through user fees.

In the newly emerging economies of developing countries, there is a substantial proportion of people who are willing and able to pay for cataract surgery at present market prices.

There is an even greater proportion who could afford to pay for the cost of cataract surgery with intraocular lens (IOL) provided the cost of the product is lowered through efficient and effective use of resources in a high volume setting.

In these times of ever increasing competition for limited government health care resources, cost recovery can become the development paradigm for comprehensive eye care development.

Revenues from cataract surgery and refraction can subsidize services to those too poor to pay as well as support delivery of other eye care services and procedures that do not have the potential to become self-sustaining from user fees by themselves.

January 2, 2001

Next: Present magnitude and major causes of visual impairment

Also see:

• Contents of Economic Benefits of Ophthalmologic Care
  
  
• Table of Contents for Vision for the Future