Cataract lens 'predatory pricing' questioned

Some ophthalmologists charge much more for cataract lens service than others, Ontario physicians said in calling for more protection for patients.

Cataract surgery is covered by public health service throughout Canada and timely access to cataract removal is considered a priority service. 

But patients who want specialty lenses that can also correct vision problems at the same time, such as nearsightedness, have to pay for them out of pocket. The specialty lenses are not considered medically necessary under most provincial health insurance plans like OHIP.

"We found that out-of-pocket prices for specialty lenses varied almost eight-fold between ophthalmologists for the same product," Dr. Chaim Bell of St. Michael’s Hospital in Toronto and his co-authors concluded in Tuesday’s issue of the journal PLoS One.

"As well, there was substantial variation in the non-lens component of the fees charged."

The majority of cataract surgeons charge less than the maximum recommended by the Canadian Ophthalmological Society for a corrective toric lens including measurement of eyesight after surgery.

But some charged $1,000 more than would could be considered reasonable or fair — a difference Bell said may represent "predatory pricing" and a "market failure."

Comparison shop for specialty lens

The investigators suggested that patients comparison shop for charges associated with the surgery knowing that there is a profit mark up to the service.

"Comparison shopping may offer substantial savings. But comparison shopping for a specialty lens is not a simple task," the study's authors noted.

"Greater access to price information and better regulatory control could help ensure patients receive the right care at a fair price."

Unlike other consumer products where people can easily search for the best price, other considerations like location come into play when shopping for healthcare, they noted. Other studies have shown people prefer local surgical centres over regional ones. 

The investigators said they had to be persistent about getting a price quote over the phone when they were initially told to book an appointment.

The variability in price of specialty lens was similar to other therapeutic services but much greater than for generic drug prices, the researchers found.

In February, CBC News Marketplace found eyeglass lenses can be very inexpensive to produce but retailers often use costly brand-name lenses, instead of offering cheaper options.

The survey findings for Ontario ophthalmologists likely apply to all jurisdictions that allow out-of-pocket payment for medical care, the study's authors said.

The telephone survey had an 88 percent response rate from eligible ophthalmologists.