Out-of-pocket expenditure for cataract surgery in rural China: a cross-sectional survey combined with hospital administrative data.

BACKGROUND: Cataract is the primary cause of blindness in China and has a low surgery uptake rate where financial factors are crucial determinants. We report updated data on the financial protection of patients with cataract surgery after the integration of urban and rural medical insurance. METHODS: A population-based survey and hospital administrative data were matched to analyze surgical and total out of pocket (OOP) costs and their burden relative to income; the proportion of total surgical costs paid OOP; and the breakdown of total surgical costs. Multivariate regressions, including key interaction terms, identified socio-demographic factors associated with OOP cost and burden. RESULTS: Among 348 cataract patients, the average surgical OOP cost incurred by patients after any reimbursements was RMB 2945 (USD 427) and total OOP costs averaged RMB 3442 (USD 499), accounting for 25.1% of annual household income. Total surgical costs averaged RMB 5,220 (USD 758), with 44.8% paid OOP and the remaining 55.2% covered by insurance. Material expenses made up 41.3% of the total surgical costs. Having supplementary health insurances and being registered as poverty-stricken households significantly reduced OOP expenditure and burden. However, supplementary insurance was associated with a significantly higher financial burden for lower-middle-income households, highlighting the vulnerability of the 'near poor'. CONCLUSIONS: Financial burden relative to income has decreased after the integration of medical insurance. However, challenges for the 'near poor' population remain. Therefore, not only expand coverage but also optimize insurance benefit design are crucial for enhancing financial protection.