According to a survey of the European Union of Medical Specialists, copayment rates should consider premium procedures to include extra work, higher skills, more surgeons risks and responsibilities. Results from the survey indicate that in half of the EU members states’ copayment for cataract surgery with premium IOLs is allowed, however, excluding Switzerland, there is a fee that covers the extra services and work that surgeons do.
The use of premium IOLs is confined to the private sector, however, in some countries, an open attitude allowed the use of premium IOLs in the public sector, with patients having to pay an extra cost for the lens.
“This is the trend, which is likely to increase in future years, but not all countries in Europe are currently accepting this policy,” Marko Hawlina, MD, PhD, past vice president of the Ophthalmology Section of the European Union of Medical Specialists (UEMS), said in a recent news release. “As part of our mission towards uniform health care in Europe, we tested the ground to find out what the situation is, before we come out with proposals for political solutions.”
The survey asked whether copayment is permitted and, if so, does it cover multifocal IOLs, toric IOLs and a fee for the extra work of the surgeon.
Results revealed that copayment is not allowed in 14 countries. Findings from the survey also showed that 8 countries introduced copayment as a general policy, while 4 countries permitted it exclusively in private centers providing national health care services.
“Countries that deny copayment justify their decision with the principle of equal rights, which constitutes the basis of universal health care. The public sector should provide the same standards of treatment for all and discourage practices that differentiate between the wealthier and the poorer,” Hawlina said. “Provided that the basic treatment is equally paid for all, patients should be granted the possibility to choose what type of lens they want implanted into their eyes and pay the extra cost out of pocket. Responders said that public centers might be less under pressure and therefore able to invest more time on individual patients for premium procedures,” he added.
The UEMS’ goal is to promote policies of copayment and reach a homogenous introduction of copayment requirements in the European Union.
“The current situation results in quite a lot of patients seeking treatment abroad. The right to cross-border health care is granted by a EU directive but generates quite a lot of confusion and eventually introduces a new form of discrimination in this case. Those who can travel abroad have the premium lens implanted and can be reimbursed in their home country for the basic cost of the procedure. Those who cannot afford to travel abroad don’t have the same right at home,” Hawlina said.
Results from the survey also made clear that in European countries which allow copayment, there is no difference between the use of multifocal and toric IOLs. Nevertheless, only one country charges an additional fee for the surgeon’s work.
According to the study, this represents omission in copayment provisions. The time between preoperative assessment, surgical procedure and follow-up, and the care and time needed to implant a premium IOLs rather than a traditional lens, are greater.
According to Hawlina, premium IOLs are not a one size fits all, as there is a need to choose the lens that better suits patients needs, lifestyle and expectations. Moreover, it requires time and a detailed testing using advanced technological equipment to accurately measure refraction, anterior and posterior corneal curvature, astigmatic axis and preferably OCT.
Another factor is related with the fact that femtosecond laser-assisted cataract surgery and automated axis display within the operating microscopes, is a very costly treatment.
“Surgery requires extra skills and expertise, a perfectly centered capsulorrhexis, and a perfect placing of the lens to avoid poor results and complications. During the follow-up, you may need to see the patients quite often to help them go through the neural adaptation process and potential problems with glare and halos. Everything ends well in most cases, but in a small percentage of unhappy patients, explantation or lens replacement might be needed, especially if the time pressure affected chair time and surgery,” he said.
Compared to monofocal IOLs, this percentage is higher and exposes the surgeon at a higher risk of legal problems.
“Premium cataract surgery is not just the lens. The form of copayment, where only the lens is allowed to be paid for, only makes the manufacturers happy. Surgeons may not be motivated, as lack of recognition of extra work and instrumentation with increased responsibilities and risks involved might in fact discourage them from implanting premium IOLs if their extra work is not accounted for,” Hawlina said.