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A Study of Principal Payer Sources 2005 Through 2009

Matthew T. Witmer, MD; Curtis E. Margo, MD, MPH; Zuber D. Mulla, PhD

Arch Ophthalmol. 2012;130(1):25-32. doi:10.1001/archophthalmol.2011.366

Objective  To describe trends in health insurance coverage for emergency department (ED) eye care in Florida from January 1, 2005, through December 31, 2009.

Methods  The Florida Agency for Health Care Administration ED data sets for ED outpatient visits and ED admissions for eye care were analyzed for type of insurance coverage and stratified according to age younger than 18 years and 18 years or older. Negative binomial regression models were used to measure the percentage of change in payer distribution for each 1-year increase in calendar year.

Results  During the 5-year study period, commercial insurance was the most frequent payer of ED outpatient services (31.1%), followed by self-pay (26.2%) and Medicaid (22.0%). For persons younger than 18 years, Medicaid and self-payment made up 67.7% of principal payers. For outpatient ED visits, the percentage of change in Medicaid increased 5.9% for each calendar year (P < .001) and commercial coverage declined 4.5% (P < .001 ). The proportion of Florida residents receiving Medicaid during the study period was less than the national average.

Conclusions  A substantial proportion of ED eye care in Florida is reimbursed through Medicaid or is paid for out of pocket. How the Patient Protection and Affordable Care Act of 2010 and the national economic recovery will affect safety-net institutions such as EDs and hospital staff is speculative, but the effect could be substantial.

Author Affiliations: Departments of Ophthalmology (Drs Witmer and Margo) and Pathology (Dr Margo), College of Medicine, and Department of Epidemiology and Biostatistics, College of Public Health (Dr Mulla), University of South Florida, Tampa; and Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso (Dr Mulla).

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