A newly published study in The Lancet Regional Health – Southeast Asia reveals a troubling healthcare gap: a large portion of India’s elderly population lacks adequate health insurance when undergoing cataract surgery, resulting in poorer visual outcomes and increased financial strain.
Study Tracks 10 Years, 40,000 Patients Across Four States
Researchers conducted a retrospective cohort study of 38,387 individuals over 70 years of age who underwent cataract surgery between 2011 and 2021. The data came from four Indian states—Andhra Pradesh, Odisha, Telangana, and Karnataka—making it one of the most comprehensive investigations of eye health access in the elderly. Despite cataract surgery being the most common eye procedure, only 16.07% of patients had any form of insurance.
Insurance Coverage Declines Sharply With Age
As per the press release, the study found a steep decline in insurance coverage as age increased. While 17.5% of patients aged 70–74 had insurance, this number dropped to less than 10% in patients over 85 and just 7.14% for those over 90. Notably, private insurance dropped from 13.32% in the 70–74 age group to 4.07% for those over 90, showing a sharp exit of private insurers from the ageing population.
Public Schemes Present But Inadequate
Although public insurance uptake slightly increased with age, it remained stagnant overall—ranging only between 3.33% and 4.21%. This suggests a systemic failure to extend adequate health coverage to the oldest and most vulnerable citizens. Many elderly Indians find current insurance schemes inaccessible, unaffordable, or not useful enough to enroll in.
Gender Disparity in Insurance Access
The study also uncovered a significant gender gap: elderly men had higher insurance coverage (19.11%) compared to women (12.43%). This highlights a need for targeted interventions to support older women, who already face multiple health and socio-economic disadvantages.
Government Policy Improves Uptake Post-2018
The launch of the Ayushman Bharat scheme in 2018 marked a turning point. Insurance uptake doubled among those aged 70 and above after the policy was introduced. In fact, the policy change was the strongest predictor of insurance coverage after 2018. Strikingly, nearly all patients (184 out of 189) who were offered free, fully subsidized care opted to switch to government insurance before undergoing surgery—indicating growing trust in public schemes when available.
Better Insurance, Better Vision
Crucially, insurance status had a direct impact on clinical outcomes. Insured patients were 1.38 times more likely to achieve good visual outcomes post-surgery, especially among those over 80. This reinforces the value of insurance not just for financial protection but for quality healthcare access.
Disparities Within the Insured Population
However, not all insurance coverage is equal. Patients with government insurance faced longer median waiting times (18 days) for surgery compared to those with private insurance (11 days). Approval processes were also three times slower under public insurance. Additionally, access to advanced care varied: 79.55% of privately insured patients received foldable intraocular lenses (IOLs), compared to just 53.46% of publicly insured patients.
Expert Insight
“We found that insurance uptake is uniformly low across India’s elderly population, and the coverage declined dramatically in patients over 80 years of age,” said Dr. Raja Narayanan, a corresponding author of the study. “Lacking insurance was associated with poorer visual outcomes following cataract surgery. This shows that universal health coverage through government insurance programmes is key to achieving health equity in our vulnerable populations.”
Dr. Brijesh Takkar, consultant ophthalmologist at the L V Prasad Eye Institute and the study’s first author, emphasized the broader implications of the findings. “This study is powerful evidence that adequate insurance coverage improves the chances of receiving timely health care while also benefiting from superior outcomes. I would argue that these findings are true not just for cataract surgery, but for all forms of health intervention. Our national health policy should insure the many who are vulnerable to financial insecurity—this has the potential to reduce the health burden overall,” he noted.