title: Is the cost the primary barrier for cataract surgery in Paraguay?
abstract: OBJECTIVE
  To determine if the cost was the main barrier to undergo cataract surgery in Paraguay.
  
  
  METHODS
  We conducted a cohort study with patients screened in the 2011 Rapid Assessment of Avoidable Blindness (RAAB) who had reported that the cost was the main barrier to undergo cataract surgery in Paraguay. All patients with operable cataract from the RAAB study and with registered telephone numbers were interviewed by telephone and were offered free surgery services. The patients who did not come for surgery were re-interviewed by telephone to analyze the reasons for not undergoing the operation.
  
  
  RESULTS
  Out of 122 patients identified in the RAAB study with barriers for cataract surgery, 69 (56.6%) reported that the surgical fee was the main barrier; 52 (75.4%) of them had their telephone numbers registered. Thirty-six (69.2%) patients did not reside in the metropolitan area of Asunción. Six patients (12%), all from Asunción, agreed to undergo free surgery. Forty-six patients did not agree the free surgery mainly due to the costs associated with their transportation (n=31, 67%) and the travel costs of their companion (n=6, 13%).
  
  
  CONCLUSIONS
  Surgery fee alone was not the major contributing factor for not undergoing cataract surgery. Place of residence and other indirect out-of-pocket expenses, such as transportation and companion-related costs appear to be more relevant. While further investigation is needed to assess if reducing the cost of transport will improve the uptake, the findings in this study suggest that a surgical package with all costs should be offered to patients of cataract surgical programs to increase cataract surgical coverage in Paraguay.
authors.affiliation: Fundación Visión, Asunción, Paraguay.
authors.forename: Harumi G
authors.initials: HG
authors.lastname: Burga
authors.affiliation: Fundación Visión, Asunción, Paraguay.
authors.forename: Celeste N
authors.initials: CN
authors.lastname: Hinds
authors.affiliation: Fundación Visión, Asunción, Paraguay.
authors.forename: Van C
authors.initials: VC
authors.lastname: Lansingh
authors.affiliation: National University of Asunción, Asunción, Paraguay.
authors.forename: Margarita
authors.initials: M
authors.lastname: Samudio
authors.affiliation: Kilimanjaro Centre for Community Ophthalmology, Moshi, Paraguay.
authors.forename: Susan
authors.initials: S
authors.lastname: Lewallen
authors.affiliation: Kilimanjaro Centre for Community Ophthalmology, Moshi, Paraguay.
authors.forename: Paul
authors.initials: P
authors.lastname: Courtright
authors.affiliation: Fundación Visión, Asunción, Paraguay.
authors.forename: Rainald
authors.initials: R
authors.lastname: Duerksen
authors.affiliation: Fundación Visión, Asunción, Paraguay.
authors.forename: Pablo
authors.initials: P
authors.lastname: Cibils
authors.affiliation: Fundación Visión, Asunción, Paraguay.
authors.forename: Manuel
authors.initials: M
authors.lastname: Zegarra
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000191:economics*; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010239:Paraguay; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014792:Visual Acuity