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Abstract
Purpose: Cataract surgery is provided both by the private and public sector in India. Free cataract surgery (with minimal amenities) funded through subsidies/reimbursements by government and non-governmental organizations is provided for underprivileged and poor patients, especially in rural areas. However, no evidence exists whether this free surgery is used by those who could afford to pay and are willing to pay for cataract surgery. So, understanding willingness to pay and preferences for cataract surgery in the population can have important policy implications.
Methods: A cross-sectional survey of 1272 households from four randomly drawn rural household clusters in Theni district, Tamilnadu state, India was conducted. Respondents from households were presented with scenarios (with and without free surgery availability) to elicit their willingness to pay and preferences for cataract surgery.
Results: Of those willing to undergo surgery; 696 (57%) were willing to undergo paid surgery, 148 (12%) only free surgery, and 378 (31%) paid surgery if no free surgery was available. In a multinomial logit model, household wealth measures, income variables and family history of cataract surgery largely distinguished the preferences. Good understanding of cataract and its intervention only marginally influenced preference for paid surgery.
Conclusion: A larger number of people were willing to pay when free surgery was not available. Free surgery may be crowding out surgery for which costs can be recovered. With non-cataract causes of blindness in the Indian population also requiring attention, this has implications for allocation of scarce resources.
Acknowledgments
We are grateful for the support of Prof. Denzil Fiebig, University of New South Wales, Australia, for data analysis. We wish to thank Mr R. D. Thulasiraj, Mr Sekar and the staff of the Diabetic Retinopathy Project, Lions Aravind Institute of Community Ophthalmology, India, for their support.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.
Financial support was provided by the Aravind Medical Research Foundation (AMRF), Madurai, India.