Why Has Cataract Surgery Become Better While Payment for It Has Fallen?
Because the profession made the operation so successful that its success was used to justify paying less for it. Over two decades, cataract surgery became faster, safer and more predictable. Complication rates fell, waiting times shortened and outcomes improved. Logically, that progress should have been valued. Instead, as the operation came to look routine, the payment attached to it was steadily reduced, while the cost of delivering it to a modern standard rose.
The result is a widening gap. Advanced diagnostics, single-use instrumentation, premium theatre standards and the time now required for counselling, consent and follow-up have all pushed the true cost of a safe operation upward.¹ Reimbursement has moved the other way. In insured practice in the United Kingdom, the per-eye fee has fallen substantially over this period, a pattern documented across health systems internationally, from Medicare data in the United States² to the shifting tariffs behind National Health Service cataract provision in England.³
None of this makes the surgery less valuable to the patient. It makes it harder to deliver well at a price that keeps falling. Understanding that gap is the first step to understanding why serious providers increasingly decline to compete on price alone, and choose instead to compete on the quality, technology and continuity of care that a modern cataract pathway genuinely requires.
References
- Portney DS, Berkowitz ST, Garner DC, Qalieh A, Tiwari V, Friedman S, Patel S, Parikh R, Mian SI. Comparison of incremental costs and Medicare reimbursement for simple versus complex cataract surgery using time-driven activity-based costing. JAMA Ophthalmology. 2023;141(4):358-364.
- Bhatt AN, Brower D, Pan E, et al. Declining Medicare payment trends in ophthalmology subspecialties, 2003 to 2024. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. 2025.
- Stringer G, Grigoroglou C, Walshe K, Ferguson J, Allen T, Anderson M, Bloor K, Gee E, Gutacker N. Public service and private profit: a mixed methods study of cataract surgery in England. Health Economics, Policy and Law. 2026;1-19.
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