Fang et al. BMC Public Health 2010, 10:543 http://www.biomedcentral.com/1471-2458/10/543 R E S E A R C H A R T I C L E Open Access Variation of cataract surgery costs in four different graded providers of China Jiahua Fang1*, Xinghua Wang2, Zhende Lin3, Jihua Yan4, Ye Yang3, Jingbo Li1 Abstract Background: China has the largest population of cataract patients in the world. However, the cataract surgery rate per million remains low in China. We carried out a survey on costs of cataract surgery from four different graded providers in China and analyzed differences in cost among these clinics. Methods: 1,189 patients were recruited for the study in four eye clinics, located in two provinces, Guangdong province in southern China and Hubei province in central China. The average cost of each cataract surgery episode was calculated including cost of intraocular lens, cost of drugs and facility cost. We also collected information on reimbursement and disposable annual income of local residents. Results: Mean total cost per cataract intervention of four different providers varied considerably, ranging from US$ 1,293 in Union Hospital to US$ 536 in Jingshan County Hospital. In all providers, except for Jingshan County Hospital, the cost exceeded annual disposable income of local rural residents. As to the proportion of patients with reimbursement, the figure for Union Hospital was only 36%, while for other three clinics it was more than 60%. There was a significant difference between mean reimbursement ratios, with the highest ratio in Zhongshan Ophthalmic Center being 71%. Conclusions: Significant differences in costs of cataract surgery were found among the 4 different graded providers. A part of the cost was borne by patients. Proportion of patients with reimbursement and mean reimbursement ratios were higher in economically developed regions than in economically developing regions. Much more financial support should be directed into the rural New Cooperative Medical Scheme to raise the reimbursement ratio in rural China. Background Cataract is a leading cause of blindness around the world. Approximately 18 million people worldwide are blind from bilateral mature cataracts[1]. In developing countries 50-90% of all blindness cases are caused by cataracts. As the world’s largest developing country, China is a country with nearly 1.4 billion population, among which there are 2.5 million cataracts with an annual increase of 400 thousand patients[2]. Removing the cataract surgically and replacing the natural lens with a synthetic intraocular lens (IOL) remain the only effective treatment for cataracts. The cataract surgery rate (CSR, the number of cataract operations performed per million populations per year) is about 5700 in the * Correspondence: nmhuman@yahoo.com.cn 1Department of Ophthalmology, First Hospital of Jingzhou, Yangtze University, Jingzhou 434000, China Full list of author information is available at the end of the article United States[3], but only about 4500 in India[4], and as low as 200 in some developing countries[5,6]. However, the CSR may vary between provinces in China, such as 1197 in Beijing, 1548 in Shanghai, 953 in Tibet, 608 in Qinghai; but only 196 in Guizhou, 216 in Chongqing[7]. In the developing world, China and India are the two most populous countries on earth and are at a roughly comparable stage of economic development, while the CSR is considerably lower in China than in India. Most of the patients who suffer from reversible blindness due to mature cataracts go untreated in China; as a result, the number of blind patients is growing every year. From a public health perspective, it is clear that senile cataract remains a leading cause of blindness in China and our population is experiencing a “backlog” of catar- act. Poor services that are inaccessible, inappropriate, or unaffordable will not be utilised and people with unoper- ated cataract will accumulate to form a surgical backlog © 2010 Fang et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.