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Original Investigation
June 2018

Comparison of Access to Eye Care Appointments Between Patients With Medicaid and Those With Private Health Care Insurance

Author Affiliations
  • 1Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland
  • 2Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
  • 3Helen Keller International, New York, New York
  • 4Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 5Department of Health Management and Policy, University of Michigan, Ann Arbor
JAMA Ophthalmol. 2018;136(6):622-629. doi:10.1001/jamaophthalmol.2018.0813
Key Points

Question  Is there a difference in access to eye care appointments between patients with Medicaid and those with private health insurance?

Findings  In this cohort study of 330 unique eye care professionals, the proportion of callers who successfully obtained eye care appointments for adults and children with Medicaid was less than that of those with private health insurance, but there was no difference identified in appointment wait times when an appointment was made.

Meaning  Difficulty obtaining appointments may explain, in part, the lower rates of use of recommended eye care services among those with Medicaid.

Abstract

Importance  Although low-income populations have more eye problems, whether they face greater difficulty obtaining eye care appointments is unknown.

Objective  To compare rates of obtaining eye care appointments and appointment wait times for those with Medicaid vs those with private insurance.

Design, Setting, and Participants  In this prospective, cohort study conducted from January 1, 2017, to July 1, 2017, researchers made telephone calls to a randomly selected sample of vision care professionals in Michigan and Maryland stratified by neighborhood (urban vs rural) and professional type (ophthalmologist vs optometrist) to request the first available appointment. Appointments were sought for an adult needing a diabetic eye examination and a child requesting a routine eye examination for a failed vision screening. Researchers called each practice twice, once requesting an appointment for a patient with Medicaid and the other time for a patient with Blue Cross Blue Shield (BCBS) insurance, and asked whether the insurance was accepted and, if so, when the earliest available appointment could be scheduled.

Main Outcomes and Measures  Rate of successfully made appointments and mean wait time for the first available appointment.

Results  A total of 603 telephone calls were made to 330 eye care professionals (414 calls [68.7%] to male and 189 calls [31.3%] to female eye care professionals). The sample consisted of ophthalmologists (303 [50.2%]) and optometrists (300 [49.8%]) located in Maryland (322 [53.4%]) and Michigan (281 [46.6%]). The rates of successfully obtaining appointments among callers were 61.5% (95% CI, 56.0%-67.0%) for adults with Medicaid and 79.3% (95% CI, 74.7%-83.9%) for adults with BCBS (P < .001) and 45.4% (95% CI, 39.8%-51.0%) for children with Medicaid and 62.5% (95% CI, 57.1%-68.0%) for children with BCBS (P < .001). Mean wait time did not vary significantly between the BCBS and Medicaid groups for both adults and children. Adults with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (odds ratio [OR], 0.41; 95% CI, 0.28-0.59; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 2.40; 95% CI, 1.49-3.87; P < .001) or with an optometrist vs an ophthalmologist (OR, 1.91; 95% CI, 1.31-2.79; P < .001). Children with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (OR, 0.41; 95% CI, 0.28-0.60; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 1.68; 95% CI, 1.04-2.73; P = .03) or with an optometrist vs an ophthalmologist (OR, 8.00; 95% CI, 5.37-11.90; P < .001).

Conclusions and Relevance  Callers were less successful in trying to obtain eye care appointments with Medicaid than with BCBS, suggesting a disparity in access to eye care based on insurance status, although confounding factors may have contributed to this finding. Improving access to eye care professionals for those with Medicaid may improve health outcomes and decrease health care spending in the long term.

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