{"title":"2011-2022年印度分散式眼科护理系统中接受白内障手术的老年人口的经济脆弱性：一项多中心回顾性队列研究","authors":"Brijesh Takkar , Ragukumar Venugopal , Mehul Mehta , Anthony Vipin Das , Varsha Rathi , Rohit Khanna , Gudlavalleti V.S. Murthy , Hemendra Kumar Vaishnav , Brijesh Kashyap , Chirantan Chatterjee , Raja Narayanan","doi":"10.1016/j.lansea.2025.100640","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The health burden of geriatric eye care is expected to rise, yet medical insurance uptake among the elderly population remains low. There is minimal evidence regarding insurance uptake for eye care among the elderly population in the Southeast Asia region. We explored insurance uptake and its impact on visual outcomes among the elderly population who visited an eye care system distributed across four Indian states.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we used a browser-based proprietary, Hospital Information Management System (HIMSS) stage six, electronic medical record (EMR) system. Datasets were collected from new patients who visited the four tertiary centres with linked primary and secondary centres of our pyramidal health system (L V Prasad Eye Institute [India]) distributed in four Indian states, Andhra Pradesh, Odisha, Telangana, and Karnataka, between August 2011 and December 2022. The electronic medical records of 38,387 patients aged >70 years who underwent cataract surgery were included (45.5% were females [17,471]). Individuals treated with fully subsidised care were excluded. Data on age, health insurance uptake, type of health insurance (government or private), and mode of payment for cataract surgery were collected. Factors impacting insurance uptake and visual outcomes were studied using logistic regression analysis.</div></div><div><h3>Findings</h3><div>Insurance uptake declined from 17.5% among people aged 70 years to less than 10% among those aged >85 years. Private insurance uptake declined from 13.3% among people aged 70 years to 4.7% among those aged 90 years, while publicly funded insurance remained between 3.3% and 4.2%. Insurance uptake increased during 2018–2022 compared to 2011–2017 (20.61% vs. 10.65%; p < 0.001). A higher proportion of males had insurance uptake compared to females. Median waiting times for surgery among patients with government versus private insurance were 18 and 11 days, respectively. Among patients aged >80 years, surgical outcomes for those without insurance were worse than for those with insurance.</div></div><div><h3>Interpretation</h3><div>Insurance uptake declined dramatically in patients aged above 80 years and was associated with poorer visual outcomes following cataract surgery, as the insurance uptake may impact the quality of eye care received. Policy changes are needed to increase insurance uptake for eye care in this population.</div></div><div><h3>Funding</h3><div><span>DBT Wellcome Trust India Alliance</span>, <span>Clinical Research Centre</span> Grant IA/CRC/19/1/610010; <span>Hyderabad Eye Research Foundation</span> (HERF).</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100640"},"PeriodicalIF":6.2000,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Financial vulnerability of the elderly population undergoing cataract surgery within a distributed eye care delivery system in India (2011–2022): a multicentre, retrospective cohort study\",\"authors\":\"Brijesh Takkar , Ragukumar Venugopal , Mehul Mehta , Anthony Vipin Das , Varsha Rathi , Rohit Khanna , Gudlavalleti V.S. Murthy , Hemendra Kumar Vaishnav , Brijesh Kashyap , Chirantan Chatterjee , Raja Narayanan\",\"doi\":\"10.1016/j.lansea.2025.100640\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The health burden of geriatric eye care is expected to rise, yet medical insurance uptake among the elderly population remains low. There is minimal evidence regarding insurance uptake for eye care among the elderly population in the Southeast Asia region. We explored insurance uptake and its impact on visual outcomes among the elderly population who visited an eye care system distributed across four Indian states.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we used a browser-based proprietary, Hospital Information Management System (HIMSS) stage six, electronic medical record (EMR) system. Datasets were collected from new patients who visited the four tertiary centres with linked primary and secondary centres of our pyramidal health system (L V Prasad Eye Institute [India]) distributed in four Indian states, Andhra Pradesh, Odisha, Telangana, and Karnataka, between August 2011 and December 2022. The electronic medical records of 38,387 patients aged >70 years who underwent cataract surgery were included (45.5% were females [17,471]). Individuals treated with fully subsidised care were excluded. Data on age, health insurance uptake, type of health insurance (government or private), and mode of payment for cataract surgery were collected. Factors impacting insurance uptake and visual outcomes were studied using logistic regression analysis.</div></div><div><h3>Findings</h3><div>Insurance uptake declined from 17.5% among people aged 70 years to less than 10% among those aged >85 years. Private insurance uptake declined from 13.3% among people aged 70 years to 4.7% among those aged 90 years, while publicly funded insurance remained between 3.3% and 4.2%. Insurance uptake increased during 2018–2022 compared to 2011–2017 (20.61% vs. 10.65%; p < 0.001). A higher proportion of males had insurance uptake compared to females. Median waiting times for surgery among patients with government versus private insurance were 18 and 11 days, respectively. Among patients aged >80 years, surgical outcomes for those without insurance were worse than for those with insurance.</div></div><div><h3>Interpretation</h3><div>Insurance uptake declined dramatically in patients aged above 80 years and was associated with poorer visual outcomes following cataract surgery, as the insurance uptake may impact the quality of eye care received. Policy changes are needed to increase insurance uptake for eye care in this population.</div></div><div><h3>Funding</h3><div><span>DBT Wellcome Trust India Alliance</span>, <span>Clinical Research Centre</span> Grant IA/CRC/19/1/610010; <span>Hyderabad Eye Research Foundation</span> (HERF).</div></div>\",\"PeriodicalId\":75136,\"journal\":{\"name\":\"The Lancet regional health. Southeast Asia\",\"volume\":\"39 \",\"pages\":\"Article 100640\"},\"PeriodicalIF\":6.2000,\"publicationDate\":\"2025-07-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The Lancet regional health. Southeast Asia\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2772368225001118\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Lancet regional health. Southeast Asia","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772368225001118","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
摘要
背景：老年人眼科保健的健康负担预计会增加，但老年人的医疗保险覆盖率仍然很低。关于东南亚地区老年人口的眼科保健保险吸收的证据很少。我们探讨了保险的吸收及其对老年人视力结果的影响，这些老年人访问了分布在印度四个邦的眼科保健系统。方法在回顾性队列研究中，我们使用基于浏览器的专有医院信息管理系统（HIMSS）第六阶段电子病历（EMR）系统。数据集是从2011年8月至2022年12月期间访问我们金字塔卫生系统（L V Prasad眼科研究所[印度]）四个三级中心的新患者中收集的，这些三级中心与我们金字塔卫生系统的初级和二级中心有联系，这些中心分布在印度四个州，安得拉邦、奥里萨邦、特伦甘纳邦和卡纳塔克邦。纳入了38387例70岁白内障手术患者的电子病历，其中45.5%为女性[17471]。接受全额补贴治疗的个人被排除在外。收集了年龄、健康保险使用情况、健康保险类型（政府或私人）以及白内障手术支付方式的数据。采用logistic回归分析研究影响保险摄取和视力结果的因素。研究发现，70岁人群的保险覆盖率从17.5%下降到85岁人群的不到10%。70岁老人的私人保险使用率从13.3%下降到90岁老人的4.7%，而公共资助的保险仍然在3.3%至4.2%之间。与2011-2017年相比，2018-2022年的保险吸收率有所增加(20.61%对10.65%；p & lt;0.001)。男性参保比例高于女性。政府保险和私人保险患者的手术等待时间中位数分别为18天和11天。在80岁的患者中，没有保险的患者手术效果比有保险的患者差。在80岁以上的患者中，保险的使用急剧下降，并且与白内障手术后较差的视力结果相关，因为保险的使用可能会影响所接受的眼科护理的质量。需要改变政策以增加这一人群的眼科保健保险。资助：dbt威康信托印度联盟，临床研究中心IA基金/CRC/19/1/610010；海德拉巴眼科研究基金会。
Financial vulnerability of the elderly population undergoing cataract surgery within a distributed eye care delivery system in India (2011–2022): a multicentre, retrospective cohort study
Background
The health burden of geriatric eye care is expected to rise, yet medical insurance uptake among the elderly population remains low. There is minimal evidence regarding insurance uptake for eye care among the elderly population in the Southeast Asia region. We explored insurance uptake and its impact on visual outcomes among the elderly population who visited an eye care system distributed across four Indian states.
Methods
In this retrospective cohort study, we used a browser-based proprietary, Hospital Information Management System (HIMSS) stage six, electronic medical record (EMR) system. Datasets were collected from new patients who visited the four tertiary centres with linked primary and secondary centres of our pyramidal health system (L V Prasad Eye Institute [India]) distributed in four Indian states, Andhra Pradesh, Odisha, Telangana, and Karnataka, between August 2011 and December 2022. The electronic medical records of 38,387 patients aged >70 years who underwent cataract surgery were included (45.5% were females [17,471]). Individuals treated with fully subsidised care were excluded. Data on age, health insurance uptake, type of health insurance (government or private), and mode of payment for cataract surgery were collected. Factors impacting insurance uptake and visual outcomes were studied using logistic regression analysis.
Findings
Insurance uptake declined from 17.5% among people aged 70 years to less than 10% among those aged >85 years. Private insurance uptake declined from 13.3% among people aged 70 years to 4.7% among those aged 90 years, while publicly funded insurance remained between 3.3% and 4.2%. Insurance uptake increased during 2018–2022 compared to 2011–2017 (20.61% vs. 10.65%; p < 0.001). A higher proportion of males had insurance uptake compared to females. Median waiting times for surgery among patients with government versus private insurance were 18 and 11 days, respectively. Among patients aged >80 years, surgical outcomes for those without insurance were worse than for those with insurance.
Interpretation
Insurance uptake declined dramatically in patients aged above 80 years and was associated with poorer visual outcomes following cataract surgery, as the insurance uptake may impact the quality of eye care received. Policy changes are needed to increase insurance uptake for eye care in this population.
Funding
DBT Wellcome Trust India Alliance, Clinical Research Centre Grant IA/CRC/19/1/610010; Hyderabad Eye Research Foundation (HERF).
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
