
Navigating Public vs. Private Ophthalmic Care for Cataract Surgery
A growing concern as the Australian population ages
As the Australian population ages, the demand for cataract surgery is on the rise.
Cataracts, a common age-related condition, can significantly impair vision and quality of life if left untreated. However, cataract surgery has high success rates and is a low risk and life changing option to restore the vision and the lifestyle of those that require surgical intervention.
Understanding public versus private ophthalmic care for cataract surgery, and the differences in expectations, wait times, and costs between these two healthcare systems is important for when considering this treatment.
Wait times and hospital admissions – the facts and figures
In 2017-18 approximately 411,000 Australians (1.7% of the population) had cataracts.
Based on National Elective Surgery Waiting Times Data* more than 100,000 admissions from waiting lists for elective eye surgery were made in 2018–19, a 2.2% increase from 2017–18.
Cataract procedures recorded the highest number of admissions (72,270) when compared to other routinely monitored elective surgeries. The median wait time for cataract surgery is 124 days for Indigenous Australians and 82 days for non-Indigenous Australians (*AIHW).
As shown in the graph below in 2017–18, private hospitals accounted for seven in 10 (70%) hospitalisations involving the eye and surrounding tissue because private hospitals provided most of the treatment for the most common diagnoses. Public hospitals usually treated the less common diagnoses. * (AIHW)
Dr Ben LaHood, who is a consulting cataract and refractive specialist at Adelaide Eye & Laser Centre, and who also consults publicly at Adelaide’s Queen Elizabeth Hospital, has previously spoken about the inequity between the cataract patient experience in the public versus private system in Australia.
Despite perceived ageism in how cataract patients in the public versus private system are treated, overall Dr Ben LaHood believes Australia is performing well compared to other countries. (Insight News)
“The idea of treating the potentially older, more difficult, denser cataract patient in public differently to the earlier, younger, easier cataract in private, has been quite ageist,” LaHood says.
“We imagine that these older patients come into the public system, have low expectations, and accept average outcomes. But we’re all living longer. The vision we’re giving people is going to dictate how they see for the rest of their life, so it’s vitally important.”
And while Australia offers good public care options, there is no denying that public wait times for cataract surgery are long and getting longer.
The delay in the timely accessibility of this routinely performed and successful procedure can result in loss of independence, functional decline, and increased risk of falls. The problem, Dr LaHood says, relates back to training more surgeons, funding more training positions in the public system and making those public positions more appealing.
Comparing the costs of cataract surgery
As with all elective surgery, there are two systems available to the Australian people who need surgical treatment for cataracts.
Public Hospital Patients
There are no costs for the procedure in a public hospital as a public patient who has Medicare.
Public healthcare systems, often funded by government sources, aim to provide equitable access to essential medical services, including cataract surgery. One of the primary advantages of public ophthalmic care is its accessibility to a broader demographic, regardless of socioeconomic status. The downside of public healthcare systems lies in the often-lengthy wait times, the reality that you do not get to choose your surgeon, and the limited IOL (Intraocular lenses) options.
Note – IOL choice and its relevance is explained later in this blog.
Private Hospital Patients
Patients often have out-of-pocket costs for the procedure in a private hospital even if they are covered by private health insurance.
For those who choose to go private and are uninsured, the costs for cataract surgery are covered completely by the patient. If applicable, Medicare rebates will still apply. As noted on the Australian Government Department of Health and Aged Care medical costs finder website, for patients with private health insurance who had a cataract surgery in a private setting across all of Australia, 56% had an out-of-pocket cost. [1]
Cataract surgeons consulting at Adelaide Eye & Laser Centre (AE&LC) choose to perform this procedure at ParkView Day Surgery , South Australia’s leading ophthalmic day hospital.
Un-insured patients of AE&LC who are planning cataract surgery can expect average total costs of $4300 per eye. Concession/Pension discounts are offered to eligible patients.
This amount is made up of the following expenses:
- Hospital fees
- Surgeon fees
- Lens fee
- Anaesthetists’ fees
- Pharmacy fee $80/eye
This amount can vary depending on the choice of lens that is decided on between the surgeon and the patient.
Insured patients (with a health fund policy covering cataract surgery) of AE&LC who are planning cataract surgery can expect the following associated out of pocket expenses.
- Excess or co-payment for hospital admission – this cost can vary depending on the agreement with the patients’ health fund policy.
- Surgeon gap – average gap $400/eye
- Anaesthetist gap – this can vary depending on the Anaesthetist and is quoted prior to surgery.
- Pharmacy fee – average cost $80/eye
In contrast, private ophthalmic care offers patients the opportunity for expedited treatment with shorter wait times, greater IOL choice, as their choice of surgeon.
However, the accessibility of private healthcare comes at a cost, often requiring patients to pay out-of-pocket or rely on private insurance coverage. The financial burden associated with private care can present challenges for individuals with limited financial means, potentially leading to disparities in access to treatment.
IOL Options – relevant in the debate
Intraocular lenses (IOL), which are implanted during cataract surgery to replace the natural and cataract affected lens of the eye, are a fundamental requirement for successful cataract surgery.
There are many types of IOL’s and the one best suited to you is determined as part of the pre-operative assessment. This will depend on each patients’ visual goals and eye health. Having access to a variety of IOL options for the surgeon to use does impact the visual outcome of cataract surgery.
Generally speaking, there are three types of intraocular lenses.
Monofocal Lenses: These lenses are the most commonly used and offer high-quality vision. They have a single focal point, typically set for distance but can be adjusted for near vision. While most patients opt for both eyes set for distance, some may choose monovision, where one eye is set for distance and the other for near vision. This is also often referred to as blended vision.
Extended Depth of Focus (EDoF) Lenses: These lenses expand the range of focus up to approximately 65cm, providing clear vision for social activities. However, detailed near vision may still require reading glasses.
Trifocal Lenses: Trifocal intraocular lenses offer near vision at 40cm, intermediate vision between 60-80cm, and distance vision by splitting incoming light. While they have several positive attributes, they may also be associated with unpredictable side effects that cannot be fully anticipated before surgery. It’s essential to discuss these potential effects with your surgeon before your procedure.
What next?
In recent years, efforts have been made to bridge the gap between public and private ophthalmic care, aiming to optimise access to cataract surgery for all patients.
Collaborative initiatives between public and private sectors, such as joint waiting lists or subsidised treatment programs, have been implemented in some regions to reduce wait times and improve access to care.
As the population continues to age, the demand for cataract surgery will inevitably increase, placing greater strain on healthcare systems in Australia.
An Affordable Cataract Surgery offer
In compassionate response to this growing issue, several of our consulting ophthalmologists can present a solution.The offer is simple, provides cost transparency, and most importantly, timely and increased affordability for those needing cataract surgery, do not want to wait, but do not have adequate medical insurance.
Providing reduced wait times, access to a specialist cataract surgeon, a better choice of IOL options, and consulting and surgical management in a purpose-built and high quality ophthalmic precinct, it is an excellent solution for those that are suitable.
To find out more about this offer speak to one of our customer service team or send us an email at aelc@aelc.com.au.
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[1] https://medicalcostsfinder.health.gov.au/services/H37#