Study links lack of insurance in elderly to poor cataract surgery outcomes

Hyderabad: A new multi-centre study has found that a significant share of India’s elderly population lacks adequate health insurance during cataract surgery, leading to poorer visual outcomes and increased financial vulnerability.

The study, published in The Lancet Regional Health, Southeast Asia (July/August 2025) by Elsevier, analysed 10 years of data from 38,387 patients above the age of 70 across Telangana, Andhra Pradesh, Odisha, and Karnataka. It is one of the most extensive retrospective cohort analyses of elderly patients undergoing cataract surgery, the most common eye operation in India.

Insurance coverage drops sharply with age

Researchers found that only 16.07% of elderly patients undergoing cataract surgery had any form of health insurance coverage. Alarmingly, insurance uptake declined sharply with increasing age:

• 17.5% among those aged 70–74

• Less than 10% in those aged over 85

• Only 7.14% in patients above 90

“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, one of the authors of the study.

Impact on health outcomes

The lack of insurance was not just a financial concern. Researchers observed a clear association between poor visual outcomes after cataract surgery and the absence of insurance.

“We noted that lacking insurance was associated with poorer visual outcomes following cataract surgery, as the insurance uptake may impact the quality of eye care received,” Dr. Narayanan added.

Dr. Brijesh Takkar, the study’s first author and an ophthalmologist at L V Prasad Eye Institute (LVPEI), Hyderabad, noted that the findings could have broader implications.

“The research provides 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,” Dr. Takkar said.

Despite schemes, uptake remains low

The study’s findings raise questions about the effectiveness of government-backed health insurance schemes in reaching the oldest segments of the population. Although several schemes offer coverage for the elderly, researchers believe that practical barriers like awareness, accessibility, and administrative hurdles may be limiting uptake.

Cataract surgery, often used as a proxy for measuring eye care access in India, is considered a cost-effective and impactful procedure. Ensuring insurance coverage for older patients could play a key role in reducing preventable vision loss, especially as India’s ageing population grows.