Cataract surgery takes an average of two years in the public sector. Will it be paid only?

Cataract surgery takes an average of two years in the public sector.  Will it be paid only?

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OfMaria Giovanna Faiella

The wait could soon double, with serious repercussions on the sight of thousands of Italians. Over 600 thousand cataract surgeries are performed every year. More than 25 thousand compatriots waiting to have the sight-saving operation

As we age, the natural lens found inside our eyes – the crystalline – progressively tends to darken, until it causes a reduction of vision. It’s the classic cataractwhich especially afflicts the elderly peoplebut it can also affect young people, for example following trauma. According to the World Health Organization, this ocular pathology is the leading cause of blindness And low vision: a visual impairment that it could be prevented for approximately 94 million people. Today, in fact, cataracts can also be resolved with a microsurgical interventionwhich can be executed on an outpatient basis: consists of replacement of the natural lens of the eye, aged and opaque, with an artificial one.
In our country, however, it is becoming more and more difficult to carry out the operation in public or affiliated facilities with the National Health Service (Ssn). The reasons? First, the long waiting lists.

Consequences of failure to intervene

On average you can wait up to two years for cataract surgery but, soon, these times could really double up, with serious repercussions on vision of thousands of compatriots, as feared by the director of the Ophthalmology Unit of the Irccs San Raffaele Hospital in Milan, Francesco Bandello, full professor of Ophthalmology and director of the School of Specialization in Ophthalmology of the Vita-Salute San Raffaele University: «The cataracts can only be operated on and the the consequence of failure to intervene is poor vision. In our country, over 600 thousand operations are carried out per year: we operate mainly on people of advanced age, who are “fragile” as they have other health problems, but also on an economic level since, in the majority of cases, they are pensioners and, if they are unable to carry out the operation in public or affiliated facilities with the National Health Service, they can’t afford to do it privately».
Already now, Mario Barbuto, president of, intervenes Iapb Italia onlusthe International Agency for the Prevention of Blindness, «in Italy there are more 25 thousand people waiting of cataract surgery.” And they could increase considerably.

Refunds reduced with the new rates

«If today in the public on average we wait two years to operate, soon the wait could double, reaching four years” warns Professor Bandello. But what is happening? The ophthalmologist explains: «With the entry into force (scheduled for April 1st but postponed further to January 1, 2025, ed) from the new rates for outpatient services, guaranteed within the Lea-Essential levels of assistance, the reimbursement expected for cataract surgery he comes reduced to around 800 eurosa figure which is not enough to cover the out-of-pocket costs (artificial lens, operating room, instruments and staff employed), so the directors of healthcare companies (public and affiliated) could decide to remodulate the offer favoring other more remunerative services (for example: hip or knee replacement) at the expense of cataract surgery. The risk is that it is no longer possible to carry out this type of intervention within the National Health Service. Thus – explains Professor Bandello – he condemns himself not to see well a large number of people That they do not have the possibility of operating privately. But the visual function it is essential for communicating and relating to the outside world: one elderly person who cannot see wellis not independent, cannot go out, read, watch TV and may encounter serious problems depressionas well as being a greater risk of fractures due to falls, with much greater costs also for the community”.

Losing your sight – in terms of stress – is like having Alzheimer’s

«For a strictly financial problem – adds the president of Iapb Italia – we are risking increasing those cconditions of low vision or blindness what then they will also cost the Health Service a hundred times more. The reduction in the rates paid for reimbursement occurred as part of a containment of healthcare costs but also because the pathology has been “downgraded”: the fact that the technologies have simplified and made the operation less invasive, often without the need for hospitalization, does not, however, exclude the physiological increase in costs; today, on average, cataract surgery costs around two thousand euros, much more than the approximately 800 euros of reimbursement made available by the National Health Service. Unfortunately – Barbuto underlines – compared to other medical and surgical services, in general the ophthalmology interventions I am considered “series B”, as it is not life-saving such as those linked to high-risk pathologies, for example oncological or cardiovascular. But, according to the WHO, people who lose their sight in old age live a long time pathological condition comparable, in terms of stressto that of those who have theAlzheimer’s. Living in darkness at a certain age is perhaps worse than losing life itself.”

Will healthcare migration increase?

The Regions could integrate, with their own resources, the reimbursement to hospitals that perform cataract operations, to prevent them from making a loss. For example, Francesco Bandello reports: «The Region Lombardy has already made it known that, if the reimbursement amount is reduced at a national level, will integrate the figure with its own funds, in order to allow hospital companies to continue carrying out this type of intervention without giving up the remunerative part. The problem, however, is that not all Regions can afford itso one is effectively created inequality that exacerbates existing differences. Furthermore, so healthcare migration would also be fueled towards those territories where cataract surgery can still be performed, without difficulty, within the National Health Service”. Inequalities between citizens which, at least in theory, should not exist since cataract surgery is included in the LEAsthe essential levels of assistance to be guaranteed throughout the national territory.

Standard crystal clear but without correction of vision defects

Most of the time, reports Professor Bandello, «in the context of National Health Service he comes guaranteed Alone the implantation of the standard artificial lens. Those more sophisticatedcan correct also astigmatism And presbyopiaare implanted only in a freelance regime. Co-payment, i.e. the regime that allows the patient to contribute to the costs of the operation, integrating the amount necessary to guarantee the implantation of a more expensive artificial lens, is not widespread in our country. In most regions it is preferred to keep the two paths separate, i.e. cataract surgery is carried out within the health service or as a freelancer. And whoever wants to implant a lens that, for example, corrects presbyopia, must pay for it out of his own pocket.” How much does it cost? «Depending on the type of lens implanted, in solvency (freelance regime, ed) can be spent from 1,500 to 4,000 euros per eye»

March 30, 2024

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