Type of Health Insurance and Access to Eye Care
JAMA Ophthalmology, June 2018
Lee et al. compared eye appointment rates and waiting periods for Medicaid members versus individuals with private insurance. They found that those with Medicaid had more difficulty getting appointments, although the time between the request for an appointment and the appointment date was similar.
In this prospective study, trained researchers called the offices of randomly selected eye care providers in 2 states to request the first-available appointment for 2 types of patients: an adult needing a diabetic eye exam and a child requiring a routine exam after a screening had indicated declining vision. The study included 330 eye care professionals in Maryland (53%) and Michigan (47%), stratified by neighborhood (urban vs. rural) and profession (ophthalmologist vs. optometrist). Each practice was called twice, once for a patient with Medicaid and once for a patient with Blue Cross Blue Shield (BCBS). Main outcome measures were the rates of successfully made appointments and the mean waiting periods from phone calls to appointments.
Overall, 603 calls were made to eye care providers (303 ophthalmologists, 300 optometrists; 69% male) from Jan. 1, 2017, to July 1, 2017. Appointment booking rates for adults were 61.5% among Medicaid members and 79.3% among those with BCBS (p < .001). For children, the respective rates were 45.4% and 62.5% (p < .001). No significant differences in waiting periods were identified between adults and children or between insurance groups.
The primary reason that patients with Medicaid could not obtain appointments was that their insurance plan was not accepted by the practice. Adults with Medicaid were significantly less likely than their BCBS counterparts to secure an appointment (odds ratio [OR], 0.41; p < .001); the odds were better if they resided in Michigan rather than in Maryland (OR, 2.40; p < .001) or sought appointments with optometrists rather than ophthalmologists (OR, 1.91; p < .001). Similarly, children with Medicaid had lower odds of obtaining appointments (OR, 0.41; p < .001), and the odds were better for residents of Michigan than of Maryland (OR, 1.68; p = .03) and for care by optometrists versus ophthalmologists (OR, 8.00; p < .001).
Difficulty obtaining appointments may help to explain lower usage rates for recommended eye care services among Medicaid members. Understanding the apparent insurance-related disparity may help guide policy makers in programs to improve eye health, the authors said.
The original article can be found here.