Need for eye care among older adults with diabetes mellitus in fee-for-service and managed Medicare.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Brown, AF; Jiang, L; Fong, DS; Gutierrez, PR; Coleman, AL; Lee, PP; Adams, J; Mangione, CM

Published Date

  • May 2005

Published In

Volume / Issue

  • 123 / 5

Start / End Page

  • 669 - 675

PubMed ID

  • 15883287

International Standard Serial Number (ISSN)

  • 0003-9950

Digital Object Identifier (DOI)

  • 10.1001/archopht.123.5.669


  • eng

Conference Location

  • United States