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Copyright: Radhakrishnan Kartha, Muralikrishnan
Copyright: Radhakrishnan Kartha, Muralikrishnan
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Abstract
In India, cataract surgeries are provided by both the private and public sectors. Free cataract surgeries (with minimal amenities), funded through subsidies/reimbursements by government and non-governmental organizations, are provided for underprivileged and poor patients. However, no evidence exists as to whether these free surgeries are used by those who could afford to pay for cataract surgery. This thesis evaluates the current assistance programme (with free surgery availability) in comparison to a hypothetical programme(without free surgery availability) using a cost-benefit analysis approach. The thesis also suggests an alternative programme that is sustainable, without any external support such as subsidies for conducting free surgeries.
Data from a cross-sectional survey of 1272 households from four randomly selected rural household clusters in the Theni district, Tamilnadu state, India were used. Respondents from households were presented with ‘scenarios’ (with and without free surgery availability) to elicit their preferences and willingness to pay (WTP) for cataract surgery.
Of those willing to undergo surgery, 57 % were willing to undergo ‘Paid Surgery’, 12% were willing to undergo ‘Free Surgery’ and 31% were willing to undergo ‘Paid Surgery if Free Surgery was not available’. In a multinomial logit model, household wealth items, income variables and a family history of cataract surgery largely distinguished the preferences. Results from interval regression models indicate that households with resources to pay have a positive WTP for cataract surgery. Results also show that ‘free surgeries’ are utilized by a significant proportion of people who might be willing to pay a positive amount. Free surgeries may be ‘crowding out’ surgeries from which costs can be recovered. From the results of a cost-benefit analysis it is clear that the cost benefit of the hypothetical programmes is greater than that of the current programme.
On the basis of the results, a theoretical self-selection model is recommended as an alternative mechanism through which cataract surgery providers can screen patients based on WTP. The self-selection model is based on the intuition that a provider can offer cataract surgery packages with different pricing and different service levels and amenities by distorting service quality. Evidence of the suggested self-selection model in practice is also given by a leading eye care provider in India.