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November 12, 1997

Cataract Extraction Rates and insurance Status

Author Affiliations

US General Accounting Office Washington, DC

JAMA. 1997;278(18):1489. doi:10.1001/jama.1997.03550180039021

To the Editor.  —Dr Goldzweig and colleagues1 have added cataract extraction to the growing list of procedures and conditions for which practice patterns differ substantially between managed care and FFS settings. The differences they found in cataract extraction rates were strikingly large, on the order of 2 to 1. Nonetheless, it is not clear what to make of these differences. Because Goldzweig and colleagues did not assess the extent to which these surgeries were indicated for the patients who underwent them, we cannot tell how much their findings reflect either overtreatment of FFS patients or undertreatment of managed care patients. Depending on which of these 2 circumstances predominates, both the nature of the problem (if any) and potential solutions would vary enormously.Thus, from both clinical and policy perspectives, the critical question is not whether managed care and FFS lead to different practice patterns, but rather what implications any such differences have