Health Insurance Significantly Improves Eye Surgery Outcomes for India's Elderly

Health insurance is playing a pivotal role in enhancing visual outcomes for India's rapidly ageing population, particularly following cataract surgery. A comprehensive study published in The Lancet Regional Health – Southeast Asia analyzed data from over 38,000 patients aged 70 and above across four Indian states—Andhra Pradesh, Telangana, Odisha, and Karnataka—between 2011 and 2022. The research revealed that elderly patients with health insurance were 1.38 times more likely to achieve favorable visual outcomes after cataract surgery compared to their uninsured counterparts.

Amidst the backdrop of an ageing population, with projections indicating that the percentage of individuals aged 65 and above will increase from 8% to 20% by 2050, this study underscores the urgent need for expanded health insurance access, particularly for the elderly and underserved rural populations. Nearly half of individuals over 60 experience some form of vision impairment, emphasizing the critical nature of this issue.

According to the study, the likelihood of regaining good vision post-surgery was significantly higher among insured patients aged 70–74, with 74.2% achieving beneficial results, compared to 61.9% of uninsured patients. The quality of care, rather than mere access to surgery, emerged as a critical factor influencing these outcomes. Dr. Aditi Sharma, lead researcher and ophthalmologist at LV Prasad Eye Institute, noted, "Higher proportions of elderly people with private insurance received advanced foldable intraocular lenses (IOLs)—79.55% compared to 53.46% for those with government insurance."

Gender disparities were also apparent in the findings, with more elderly males receiving modern IOLs than females. The study indicated that 54.67% of males received foldable IOLs, while only 49.18% of females did. Additionally, the quality of care seemed to decline with age; for those over 80, only 44.49% received advanced lenses compared to 53.08% of younger patients.

The research highlighted a troubling trend: as patients aged, both insurance coverage and visual outcomes decreased. The highest insurance uptake was among those aged 70–74 (17.52%), dropping significantly among older age groups. Government insurance coverage remained persistently low, particularly among the oldest citizens, with only 7% of individuals over 90 years old insured for cataract surgery.

Geographic and socioeconomic factors further complicated the landscape of healthcare access. The study found rural residents had markedly lower insurance uptake, with an odds ratio of 0.18 compared to metropolitan areas. Socioeconomic status also influenced outcomes; insured patients from lower-middle-class backgrounds were less likely to benefit from insurance than those from upper-class categories. Overall, 6,170 patients benefited from insurance, with the majority being from lower-middle-class backgrounds.

The introduction of the Ayushman Bharat insurance scheme in 2018 marked a significant shift in healthcare accessibility, increasing insurance uptake from 10.65% to 20.61%. Patients who underwent surgery after 2018 were significantly more likely to be insured, with an odds ratio of 2.65. However, the study also revealed that insured patients experienced longer waiting times for surgery, averaging 13 days compared to 6 days for uninsured patients—highlighting a paradox in which insurance improves access but introduces delays.

Despite these challenges, the demand for insured cataract surgeries continues to rise, indicating a growing awareness of the importance of insurance in maintaining ocular health. The findings reveal critical vulnerabilities within India's healthcare system that disproportionately affect its elderly citizens. With financial dependency on family members prevalent among the oldest demographic, increasing insurance coverage is essential for safeguarding their health outcomes. As the data reveals concerning disparities, particularly in insurance uptake among the oldest citizens, policymakers must prioritize equitable healthcare access to improve not only financial security but also the overall health of India's ageing population.