Household preferences for cataract surgery in rural India: a population-based stated preference survey.
OBJECTIVE
Cataract surgery is provided both by the private and public sector in India. Free cataract surgery (with minimal amenities) funded through subsidies/reimbursements by government and non-governmental organizations is provided for underprivileged and poor patients, especially in rural areas. However, no evidence exists whether this free surgery is used by those who could afford to pay and are willing to pay for cataract surgery. So, understanding willingness to pay and preferences for cataract surgery in the population can have important policy implications.


METHODS
A cross-sectional survey of 1272 households from four randomly drawn rural household clusters in Theni district, Tamilnadu state, India was conducted. Respondents from households were presented with scenarios (with and without free surgery availability) to elicit their willingness to pay and preferences for cataract surgery.


RESULTS
Of those willing to undergo surgery; 696 (57%) were willing to undergo paid surgery, 148 (12%) only free surgery, and 378 (31%) paid surgery if no free surgery was available. In a multinomial logit model, household wealth measures, income variables and family history of cataract surgery largely distinguished the preferences. Good understanding of cataract and its intervention only marginally influenced preference for paid surgery.


CONCLUSIONS
A larger number of people were willing to pay when free surgery was not available. Free surgery may be crowding out surgery for which costs can be recovered. With non-cataract causes of blindness in the Indian population also requiring attention, this has implications for allocation of scarce resources.
Cambridge Institute of Public Health, University of Cambridge , Cambridge , UK .
Muralikrishnan
M
Radhakrishnan
Rengaraj
R
Venkatesh
Vijayakumar
V
Valaguru
Kevin D
KD
Frick
D000328:Adult; D001294:Attitude to Health; D002386:Cataract / Q000191:economics*; D002387:Cataract Extraction / Q000191:economics* / Q000523:psychology*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics; D006302:Health Services Research; D006306:Health Surveys; D006801:Humans; D007194:India / Q000453:epidemiology; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000191:economics*; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
Cataract; India; cataract surgery; household; preference; willingness to pay