• Effect of Medicaid Expansion on Rates of Dilated Eye Exams

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD

    Journal Highlights

    Ophthalmology, July 2020

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    In the first study to do so, Chen et al. explored the effect of Medicaid expansion and the frequency of dilated eye exams among adults with diabetes. They found that even though the expansion initially resulted in many exams being performed, the effect was short-lived and became insignificant by 2017, despite little change in the number of insured members.

    This retrospective review entailed a difference-in-differences (DiD) anal­ysis of individual-level survey data for a nine-year period in the United States. Eligible for study entry were adults with previously diagnosed diabetes (18-64 years of age) whose household income was below 138% of the U.S. federal poverty level. Using data from the CDC’s Behavior Risk Factor Sur­veillance System, the authors identified survey responders who had been asked about dilated eye exams in the period before and after Medicaid expansion. The main outcome measure was the DiD in the proportion of dilated eye exams received.

    There were 52,392 survey respond­ers, representing all 50 states and the District of Columbia. Medicaid expansion led to a 1.3% increase in the confidence interval and a 2.3% jump in the proportion of dilated eye exams, through four years after the expansion effort. The increase in exam rates was most significant within the two years follow­ing expansion. When ex­cluding the states that were first to adopt the expansion, findings were similar.

    Health care policymakers “should be aware that addi­tional measures beyond ex­panding insurance coverage may be necessary to increase and sustain the rate of dilated eye examinations among diabetic populations,” the authors said. Clearly, increasing the availability of insurance coverage may not be enough to boost access to regular eye care among diabetic patients. The authors concluded that continued improve­ment in this quality-of-care metric “requires further specific measures targeting insured, at-risk populations, such as new care-delivery models and education initiatives.” (Also see related commentary by Andrew Bindman, MD, in the same issue.)

    The original article can be found here.