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Arleen F. Brown, MD, PhD; Luohua Jiang, MS; Donald S. Fong, MD, MPH; Peter R. Gutierrez, MS; Anne L. Coleman, MD, PhD; Paul P. Lee, MD, JD; John Adams, PhD; Carol M. Mangione, MD, MSPH

Arch Ophthalmol. 2005;123:669-675.

Objective  To compare rates of need for eye care among Medicare beneficiaries with network-model Medicare+Choice (MC) and fee-for-service (FFS) health insurance.

Methods  Cross-sectional study of a random sample of MC and FFS community-dwelling Medicare beneficiaries with diabetes who are older than 65 years of age in Los Angeles County. Study ophthalmologists masked to the participants’ type of health insurance performed standardized dilated eye examinations and indicated the need for ophthalmic care during the next 6 months. To evaluate the association between type of insurance and need for treatment, we constructed logistic regression models adjusted for participant sociodemographic and clinical characteristics.

Results  The 311 MC and 107 FFS respondents reported comparable rates of eye care provider visits and preexisting eye diseases. However, on masked clinical examination, MC respondents were more likely to have diabetic retinopathy, visually significant cataract, glaucoma, or suspected glaucoma than FFS participants (68% vs 46%, P<.001). In multivariate analyses, persons enrolled in MC were significantly more likely than FFS participants to require further treatment during the next 6 months (42% vs 24%, P = .01).

Conclusions  Data from standardized study ophthalmic examinations suggest high rates of unrecognized and untreated eye diseases among Medicare beneficiaries enrolled in both FFS and MC and significantly higher rates of need for care among MC participants.

Author Affiliations: Department of Medicine (Drs Brown and Mangione, Ms Jiang, and Mr Gutierrez), Jules Stein Eye Institute (Dr Coleman), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles; Kaiser Permanente Southern California, Pasadena (Dr Fong); Department of Ophthalmology, Duke Eye Center, Durham, NC (Dr Lee), RAND, Santa Monica, Calif (Dr Adams).

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