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Variations in cataract extraction rates in Medicare prepaid and fee-for-service settings.

Publication ,  Journal Article
Goldzweig, CL; Mittman, BS; Carter, GM; Donyo, T; Brook, RH; Lee, P; Mangione, CM
Published in: JAMA
June 11, 1997

OBJECTIVE: To compare rates of cataract extraction in 2 prepaid health settings and in traditional fee-for-service (FFS) settings. DESIGN: A cross-sectional analysis using 1993 health maintenance organization (HMO) Medicare claims and encounter files, the Health Care Financing Administration (HCFA) 5% Medicare Part B provider/supplier file, and the HCFA October 1992 100% Medicare population file. SETTING: Southern California Medicare FFS settings and the staff-model and independent practice association (IPA) plans of a large California HMO. PATIENTS: 1993 Medicare beneficiaries aged 65 years and older. The study included 43387 staff-model HMO enrollees, 19050 IPA enrollees, and 47 150 FFS beneficiaries (a 5% sample of all Southern California FFS beneficiaries). MAIN OUTCOME MEASURE: Age and risk-factor adjusted rates of cataract extraction per 1000 beneficiary-years. RESULTS: After controlling for age, sex, and diabetes mellitus status, FFS beneficiaries were twice as likely to undergo cataract extraction as were prepaid beneficiaries (P<.01). Female FFS beneficiaries were nearly twice as likely to undergo the procedure as were male FFS beneficiaries (P<.001); there were no extraction rate differences by sex in the prepaid settings. CONCLUSION: Because of the potential implications for vision care in the elderly, the significantly different rates of cataract extraction in FFS and prepaid settings warrant further clinical investigation to determine whether there is overuse in FFS vs underuse in prepaid settings. Such investigations must assess the appropriateness of cataract surgery by evaluating its use relative to clinical need.

Duke Scholars

Published In

JAMA

ISSN

0098-7484

Publication Date

June 11, 1997

Volume

277

Issue

22

Start / End Page

1765 / 1768

Location

United States

Related Subject Headings

  • United States
  • Sex Distribution
  • Multivariate Analysis
  • Medicare
  • Male
  • Logistic Models
  • Likelihood Functions
  • Independent Practice Associations
  • Humans
  • Health Maintenance Organizations
 

Citation

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Chicago
ICMJE
MLA
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Goldzweig, C. L., Mittman, B. S., Carter, G. M., Donyo, T., Brook, R. H., Lee, P., & Mangione, C. M. (1997). Variations in cataract extraction rates in Medicare prepaid and fee-for-service settings. JAMA, 277(22), 1765–1768.
Goldzweig, C. L., B. S. Mittman, G. M. Carter, T. Donyo, R. H. Brook, P. Lee, and C. M. Mangione. “Variations in cataract extraction rates in Medicare prepaid and fee-for-service settings.JAMA 277, no. 22 (June 11, 1997): 1765–68.
Goldzweig CL, Mittman BS, Carter GM, Donyo T, Brook RH, Lee P, et al. Variations in cataract extraction rates in Medicare prepaid and fee-for-service settings. JAMA. 1997 Jun 11;277(22):1765–8.
Goldzweig, C. L., et al. “Variations in cataract extraction rates in Medicare prepaid and fee-for-service settings.JAMA, vol. 277, no. 22, June 1997, pp. 1765–68.
Goldzweig CL, Mittman BS, Carter GM, Donyo T, Brook RH, Lee P, Mangione CM. Variations in cataract extraction rates in Medicare prepaid and fee-for-service settings. JAMA. 1997 Jun 11;277(22):1765–1768.
Journal cover image

Published In

JAMA

ISSN

0098-7484

Publication Date

June 11, 1997

Volume

277

Issue

22

Start / End Page

1765 / 1768

Location

United States

Related Subject Headings

  • United States
  • Sex Distribution
  • Multivariate Analysis
  • Medicare
  • Male
  • Logistic Models
  • Likelihood Functions
  • Independent Practice Associations
  • Humans
  • Health Maintenance Organizations