In this issue of the Archives, Witmer et al1 describe the changing nature of payer distributions for emergency department (ED) provision of eye care in the state of Florida between 2005 and 2009, both for outpatient ED visits and visits that result in an admission.1 By providing detailed information in their article and tables, Witmer et al1 illuminate several key points. First, in their Table 3, the more than 25% increase in reimbursement by Medicaid for ED visits (from 20.8% to 26.3%) between 2005 and 2009 occurred essentially in 2008 and especially in 2009. This 5.5 percentage point increase corresponded to a 5.9 percentage point decrease in commercial insurance visits (from 33.3% to 27.4%) and a 2.1 percentage point decrease in worker's compensation visits (from 4.9% to 2.8%). At the same time, the proportion of self-pay visits, used as a proxy for uninsured status in their article,1 was essentially unchanged during this time (at around 26%). Thus, the deep recession precipitated by the collapse of the housing bubble and the associated financial consequences, which were felt particularly hard in Florida, did not appear to increase the number of uninsured seeking eye care in EDs across the state. Instead, the proportion of care paid for by Medicaid increased, suggesting that this safety net (and 2-income households) mitigated the effect of financial distress during this time. This illustrates the importance of assessing the role of the uninsured and potentially underinsured in understanding health care use, because those with Medicaid often have greater difficulty in finding providers for office-based care.
Lee P, Dzau J. Emergency Department Use for Eye Care Services and Future Directions in Care. Arch Ophthalmol. 2012;130(1):106-107. doi:10.1001/archophthalmol.2011.383