Do we understand the effects of 'managed care' in ophthalmology? A review and analysis
S. Asch, C. L. Goldzweig and P. Lee
Health Sciences Program, RAND, Santa Monica, Calif, USA.
Little has been published that directly assesses the effect of structures
for providing managed care or the effects of capitated, prepaid financing
on the cost and quality of eye care services. Managed care organizations
use fewer ophthalmologists and may provide more screening for diabetic
retinopathy. Studies of nonophthalmologic care show lower patient
satisfaction with care, and mixed effects on cost, quality of care, and
access to care, but are difficult to generalize to eye care. We reviewed
the published peer-reviewed literature about this topic. Notable gaps exist
in the knowledge of critical elements of the influence of managed care on
providing eye care and on patient outcomes. Existing measures of quality,
cost, satisfaction, and access could easily be adapted for use in
evaluating the influence of managed care and guiding health care policy.
