Epidemiol Health.
2024;46(1):e2024015. 10.4178/epih.e2024015.
An epidemic of cataract surgery in Korea: the effects of private health insurance on the National Health Insurance Service
- Affiliations
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- 1Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- 2Department of Family Medicine, Seoul National University, Seoul, Korea
- 3HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, Korea
- 4Department of Anesthesia & Perioperative Care, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- 5Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- 6Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- 7Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
- 8Health Insurance Review & Assessment Service, Wonju, Korea
- KMID: 2554619
- DOI: http://doi.org/10.4178/epih.e2024015
Abstract
OBJECTIVES
In Korea, the National Health Insurance Service (NHIS) covers essential healthcare expenses, including cataract surgery. To address concerns that private health insurance (PHI) might have inflated the need for such procedures, we investigated the extent of the PHI-attributable increase in cataract surgery and its impact on NHIS-reimbursed expenses.
METHODS
This retrospective, observational study uses nationwide claims data for cataract surgery from 2016 to 2020. We examined trends in utilization and cost, and we estimated the excess numbers of (1) cataract operations attributable to PHI and (2) types of intraocular lenses used for cataract surgery in 2020.
RESULTS
Between 2016 and 2020, a 36.8% increase occurred in the number of cataract operations, with increases of 63.5% and 731.8% in the total healthcare costs reimbursed by NHIS and PHI, respectively. Over a 5-year period, the surgical rate per 100,000 people doubled for patients aged <65 years (from 328 in 2016 to 664 in 2020). Among the 619,771 cases in 2020 of cataract surgery reimbursed by the Korean diagnosis-related group system, more non-NHIS-covered intraocular lenses were used for patients aged <65 years than ≥65 years (68.1 vs. 14.2%). In 2020 alone, an estimated 129,311 excess operations occurred, accounting for an excess cost of US$115 million.
CONCLUSIONS
A dramatic increase in the number and cost of cataract operations has occurred over the last 5 years. The PHI-related increase in operations resulted in increased costs to NHIS. Measures to curtail the non-indicated use of cataract surgery should be implemented regarding PHI.
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