In order to investigate the twenty-one year changes in the number of ophthalmic surgeries in each specialized field, the overall number of ophthalmic surgeries, number of ophthalmologists, healthcare expenditure on ophthalmology and the ratio of the surgical expenditures in each specialized field to total expenditures of ophthalmic surgeries, data was extracted from the Survey of Medical Care Activities in Public Health Insurance, the Survey of Physicians, Dentists and Pharmacists, and the Survey of Medical Institutions and Hospital Report by the Ministry of Health, Labour and Welfare of Japan from 1996 to 2016. During this time, the number of ophthalmic surgeries in Japan increased by 40.2% overall. Concerning the detailed number of surgeries in each specialized field, the largest increase was noted for pars plana vitrectomy (1089%), followed by cataract surgery (168%), invasive glaucoma surgery (95%), and retinal coagulation surgery (29.6%). Conversely, the number of ocular adnexal surgeries, sclerocorneal surgeries, and glaucoma coagulation surgeries experienced a reduction of 3.5%, 39.8% and 25.8%,respectively. The number of ophthalmologists increased by 19.7% in the 21 years, showing a gradual increase overall; however, the rate of increase is smaller compared to the growth rate of total number of physicians at 32.6%. The numbers of ophthalmologists characterized by workplace shows a very small number working for hospitals (1924 at medical education institutions and 2782 at general hospitals) compared to the total number of hospitals of 8442 nationwide in 2016 in Japan. The healthcare expenditure on ophthalmology in Japan increased by 93.8% over the last 21 years, in parallel with the increase in the total healthcare expenditure of 76.6% and that on ophthalmic surgeries of 78.8%, comprising approximately 4% of the total healthcare expenditure throughout the last 21 years. Of the healthcare expenditure on ophthalmic surgeries in 2016, costs for cataract surgeries comprised 59.1%, representing the largest proportion, followed by the costs for pars plana vitrectomy and retinal coagulation at 17.6% and 10.7%, respectively. The expenditure on these three procedures comprised 87.4% of the total expenditure on ophthalmic surgeries. Of total ophthalmic surgery, the proportion of medical expenditure on cataract surgery has been increasing and has always represented the largest category throughout the last 21 years; however, expenditures on non-surgical treatment for cataracts have seen a marked reduction, and the medical expenditures on total cataract care, including outpatient visits, such as surgeries, examinations, and medications decreased to 86.1% (-13.9%) in 2016 compared to the average from 1996 to 1998. The proportion of total expenditures on cataract care among the total expenditures on ophthalmology was 43.1% in 1996, which experienced a sharp decline to 19.4% in 2016.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 123: 745-763, 2019.