When a patient undergoes an operation in a “fee-for-service” (FFS) setting, where the bill is paid either by the patient or the insurance company, the doctor usually gets far more money than when the patient is with a health maintenance organization (HMO).

It’s not surprising, then, to find out that patients in FFS setting are twice as likely to be subjected to cataract operations as their HMO counterparts, according to an article in The Journal of the American Medical Association.

A study was done by a medical doctor where rates were compared of cataract operations in a prepaid health setting and in traditional FFS settings.

Cataract extraction is one of the most common surgical procedures performed in the Medicare population, and accounts for Medicare’s single largest expenditure.

The conclusion of the study was that the decision to recommend surgery is often made not on what is best for the patient but on how much will be paid for the procedure.

The researchers of the study noted that if cataract surgery is being underused in HMO settings because it’s not lucrative, “this would have important implications for visual disability, which if uncorrected, can lead to poor quality of life, greater risks for falls, etc.

SOURCE: The Journal of the American Medical Association, June 11, 1997.