Patient Participation in Free Cataract Surgery: The Low-income Elderly in Urban China

Age-related cataracts remain the leading cause of treatable blindness in China. The prevalence of cataract blindness continues to climb due to the expanding elderly subpopulation. Surgery is the only available treatment; however, the cataract surgical rate (CSR) in China remains relatively low (772 cases per million per year) relative to affluent countries (6000 cases per million per year) or certain developing areas (2672 cases per million per year). Studies have reported that the primary barrier to cataract surgery is financial difficulty, and this challenge could be efficiently addressed by reducing the surgical fee1 or providing free cataract surgery. However, the prices, availability and affordability of medicines or medical services to the poor in China require further improvement, according to the standards developed by the World Health Organization (WHO) in collaboration with Health Action International (HAI) in May 2003. Although a host of free cataract screening and surgery programs have been widely implemented in rural areas of China in conjunction with a new national healthcare reform officially launched in 2009 to tackle high medical expenses, including promoting free medical treatments, free cataract surgery programs have rarely been implemented in financially-challenged urban China. Even in Guangzhou, one of the largest metropolises in China, many low-income cataract patients, a neglected cohort, continue to need cataract surgery. A program titled "care for your eyes, lighten your life", jointly sponsored by the People's Government of Guangzhou Municipality, the Bureau of Civil Affairs of Guangzhou Municipality, and the Zhongshan Ophthalmic Center (ZOC), has been initiated in Guangzhou to implement a program of free clinics in parks and free cataract surgery targeting the impoverished population living in urban China in 2012.13 After 3 years' exploration, the management mode of this program has been perfected, and approximately 4000 cataract surgeries had been performed on the low-income elderly.

Although there are a large number of poor communities throughout the country, free cataract surgery programs in poor urban China are restricted to several metropolises due to limited medical resources and social overlook. Fully understanding patient satisfaction regarding the free cataract surgery program and understanding the patient characteristics of this special, neglected community may contribute to the improvement and the further expansion of the management mode of free cataract surgery programs. In this telephone survey, the investigators aimed to investigate the characteristics of the low-income patients undergoing free cataract surgery, including patient demographics, patient resource, health conditions, reasons for choosing the free surgery, and overall evaluation of the free cataract surgery program.