Fang et al. BMC Public Health 2010, 10:543 http://www.biomedcentral.com/1471-2458/10/543 Page 3 of 7 Figure 1 Locations of four different graded providers in two provinces of China. number of cataract surgeries during November 2009 per- formed in ZOC was ten times more than in the other three hospitals. The proportion of patients from rural areas in JCH reached 43%, while for the other three bigger hospitals was very low. Phacoemulsification procedure was the primary surgery used in all four hospitals and extra- capsular cataract extraction (ECCE) was seldom used in these hospitals. The proportion of ECCE in these clinics was less than 2 percent. The average length of stay in ZOC and JCH was one day, but more than one week in UH and FHJ. Characteristics of the four clinics and catar- act surgeries were shown in Table 1. The average total costs for one cataract surgery epi- sode in four clinics were 1,089 US$ (median, 973 US$; range, 713 US$ to 2,122 US$) in ZOC, 1,293 US$ (med- ian, 1,236 US$; range, 794 US$ to 2,345 US$) in UH, 925 US$ (median, 930 US$; range, 681 US$ to 1,170 US $) in FHJ and 536 US$ (median, 526 US$; range, 526 US$ to 685 US$) in JCH. The costs of cataract surgery in two provincial hospitals were twice as many as in JCH (Figure 2). There was no qualified cataract surgeon in JCH, just like the majority of county hospitals in China. Qualified surgeons from provincial capital carried portable phacoemulsifier to JCH to perform cataract Table 1 Characteristics of the four clinics and cataract surgery Clinic Inhabitants in catchment area for cataract surgery Number of cataract surgeries in 2009 Number of cataract surgeries during study month (November 2009) Number of patients Median age of patients(y) Male (%) Number of patients from rural region Percentage of phaco-procedures during study month Average length of stay (days) Proportion of cases with foldable lens Number of patients with reimbursement Mean reimbursement ratio Number of cataract surgeons in 2009 ZOC 96,380,000 13,348 1,102 1,038 71 47% 126(12%) 99% 1 100% 766(74%) 71% 17 UH 57,200,000 866 82 78 66 43% 5(6%) 99% 8 99% 28(36%) 50% 4 FHJ 6,450,000 510 46 45 69 52% 5(11%) 98% 9 0% 30(67%) 45% 2 JCH 640,000 353 28 28 67 54% 12(43%) 100% 1 7% 20(71%) 48% 0