Regional inequalities in the supply of ophthalmologists and the volume of cataract surgeries between the public and private health sectors in Brazil.

Abstract

Purpose: This study aimed to evaluate disparities in the distribution of ophthalmologists and the volume of ca-ta-ract surgeries across Brazil, considering public and private health sectors and the country's federative units.

Methods: Data on ophthalmologists were obtained from the National Medical Residency Commission and the Associação Médica Brasileira. Information on cataract surgeries performed through the Unified Health System was collected from the DATASUS database, while data on procedures covered by private health plans were retrieved from the National Supplementary Health Agency. Population estimates from the 2024 Demographic Census of the Brazilian Institute of Geography and Statistics were used to calculate physician density and surgery rates per 100,000 inhabitants. Associations between the number of ophthalmologists and cataract surgery volume were analyzed using Spearman's correlation coefficient.

Results: Brazil has 16,784 ophthalmologists, representing 8.96 specialists per 100,000 inhabitants. Marked disparities were observed: large cities (>500,000 inhabitants) had 18.75 ophthalmologists per 100,000 residents, whereas municipalities with <50,000 inhabitants had fewer than one. Across federative units, physician density ranged from 19.18 per 100,000 in the Federal District to 4.22 in Maranhão. In 2024, cataract surgery rates varied widely, from 1,012.61 per 100,000 inhabitants in the Southeast to 435.00 in the North. Nationally, Unified Health System performed 736.30 surgeries per 100,000 inhabitants, compared with 1,276.79 in the private sector. On average, each ophthalmologist performed 96.92 cataract surgeries annually.

Conclusion: Significant inequalities persist in the geographic distribution of ophthalmologists and in cataract surgery provision, with higher surgical volumes concentrated in the private sector. Targeted policies are required to address regional disparities and improve the equity and efficiency of cataract care delivery in Brazil.