Fang et al. BMC Public Health 2010, 10:543 http://www.biomedcentral.com/1471-2458/10/543 Page 4 of 7 Figure 2 Boxplots showing the average cost for each cataract surgery episode from four different graded providers during November 2009. Horizontal lines in each box plot represent (bottom to top) 10th, 25th, 50th (median), 75th, and 90th percentiles. Values above the 90th and below the 10th percentile are plotted as stars. The abbreviations used are: ZOC, Zhongshan Ophthalmic Center; UH, Union Hospital; FHJ, First Hospital of Jingzhou; JCH, Jingshan County Hospital. surgery once or twice a month and received a medical consultation fee. The different components of cataract surgery costs identified so far are summarized in Figure 3. The mean costs of intraocular lens in four clinics were 364 US $(median, 289 US$; range, 273 US$ to 1,379 US$) in ZOC, 392 US$(median, 347 US$; range, 127 US$ to 579 US$) in UH, 170 US$(median, 162 US$; range, 162 US$ to 191 US$) in FHJ and 129 US$(median, 118 US$; range, 118 US$ to 279 US$) in JCH(Figure 4). Large dif- ferences were found among the 4 clinics. Multi-focal Figure 3 Components of cataract surgery costs in four different graded providers. The abbreviations used are: ZOC, Zhongshan Ophthalmic Center; UH, Union Hospital; FHJ, First Hospital of Jingzhou; JCH, Jingshan County Hospital. Figure 4 The average cost for intraocular lens from four different graded providers in November 2009. Horizontal lines in each box plot represent (bottom to top) 10th, 25th, 50th (median), 75th, and 90th percentiles. Values above the 90th and below the 10th percentile are plotted as stars. The abbreviations used are: ZOC, Zhongshan Ophthalmic Center; UH, Union Hospital; FHJ, First Hospital of Jingzhou; JCH, Jingshan County Hospital. intraocular lens or adjustable intraocular lens (24/1108, 2.16%) cost more than 1,100 US$, which was only used in ZOC. All patients in ZOC were implanted foldable lens, but rigid lens were used in FHJ and JCH. The cost of the cheapest lens used was 118 US$ in JCH. There were 16 different types of lens used in ZOC, but only 2 types of lens used in FHJ and JCH. The major part of cost was the use of antibiotics by intravenous infusion in UH and FHJ. Cataract surgeries in the two hospitals were performed via corneal limbal incision, and patients had been given antibiotics once a day after operation for 3 to 7 days aiming to prevent infection. Then, the length of stay was one week or so. The average cost of antibiotics for each patient was more than 200 US$. However, a clear corneal incision was used in ZOC and JCH, and patients stayed for one day without intravenous infusion of drug. The main cost for drugs in the two hospitals was the fee for eyedrops. The number of patients with reimbursement was 766 (74%) in ZOC, 28(36%) in UH, 30(67%) in FHJ and 20 (71%) in JCH. Not all patients received reimbursement. The patients had to pay first, and then were “reim- bursed” by the insurance company or rural New Coop- erative Medical Scheme (NCMS). In ZOC, the mean reimbursement ratio (reimbursement/cost) was approxi- mately 71%, ranging from 30% to 95%. The cost of the surgery didn’t vary according to whether the patient had insurance. As a part of urban residents didn’t get health insurance and reimbursement ratio for rural residents was quite low, a part of the cost was paid by the patients directly.