An epidemic of cataract surgery in Korea: the effects of private health insurance on the National Health Insurance Service

Abstract

Background:In Korea, the National Health Insurance Service (NHIS) covers essential healthcare expenses, including cataract surgery. Tohere are address concerns that private health insurance (PHI) might have boosinflated athe need for such procedurescataract surgery., Wwe investigated the extent of the PHI-attributable increase in cataract surgery and its impact on NHIS-reimbursed expenses.Methods: This is a retrospective, observational study usesing nationwide claims data for cataract surgery from 2016 to 2020. We examined the trends in the utilization and cost, and we estimated the excess numbers of 1) cataract surgeries proceduresoperations attributable to PHI and 2) types of intraocular lenses used for cataract surgery in 2020. Results: Between 2016 and 2020, there was a 36.8% increase occurred in the number of cataract surgical surgery proceduresoperations, with increases of 63.5% and 731.8% increase in the total healthcare costs reimbursed by NHIS and PHI, respectively. Over a 5-5-years period, the cataract surgicalery rate per 100,000 people doubled in thefor patients aged <65 years age group (from 328 in 2016 to 664 in 2020). Among the 619,771 cases in 2020 of DRGreimbursed cataract surgery reimbursed by the Korean diagnosis-related group system done in 2020, more non-NHIS-covered intraocular lenseIOLs were used in thefor patients aged <65 years age group than the ≥65 years age group (68.1% vs.14.2%). TIn 2020 alone, anhe estimated 129,311 excess number of surgerical procedureesoperations was 129,311 in 2020 aloneoccurred, which accountinged for an excess cost of $115 million. Conclusion:There has been aA dramatic increase in the number and cost of cataract surgeries proceduresoperations has occurred over the last 5 years. The PHI-related increase in 메모 포함[오전1]: Here and in some other contexts, a plural form is necessary, but some style guides argue about the use of "surgeries" as a plural noun. For instance, AMA style bans it in this context (https://academic.oup.com/amamanualofstyle/book/27 941/chapter/207567296#395781925; "Surgery is what a surgeon practices or a particular medical specialty. An operation is what a surgeon performs. In this context, there is no such word as surgeries.") "Surgical the number of surgeriesproceduresoperations also resulted in increased costs to NHIS. Measures to curtail the non-indicative indicated use of cataract surgery need toshould be implemented in relation withregarding PHI.