Noninsured services provided with insured cataract surgery in Canada: ensuring transparent and fair treatment for patients.

©2015 8872147 Canada Inc. or its licensors CMAJ 1 Cataract surgery is the most commonly performed medically necessary procedure in Canada, and the costs are covered under provincial and territorial health insurance plans. Patients who require this surgery are frequently offered one or more of a number of optional services related to refractive correction during cataract surgery. These services, which include innovative diagnostics, laser therapies and surgical devices, are supplied at additional cost to the patient because they are not deemed to be medically necessary by government funding agencies across Canada. These non insured technologies may allow for more predictable refractive results, freedom from the need for corrective lenses, and enhanced quality of vision over and above the benefits of cataract removal, and they are often provided in conjunction with publicly insured cataract surgery. Ophthalmologists who provide non insured services during insured surgical procedures must consider specific ethical challenges. These challenges may also apply to other specialties in which non insured services are routinely provided during insured consultations or procedures. We discuss these ethical considerations and propose a framework for ensuring that patients are properly and fairly informed about their choices for surgery.