Comparison of access to eye care appointments between patients with medicaid and those with private health care insurance

Yoon H. Lee, Andrew X. Chen, Varshini Varadaraj, Gloria H. Hong, Yimin Chen, David S Friedman, Joshua D. Stein, Nicholas Kourgialis, Joshua R. Ehrlich

Research output: Contribution to journalArticle

Abstract

IMPORTANCE Although low-income populations have more eye problems, whether they face greater difficulty obtaining eye care appointments is unknown. OBJECTIVE To compare rates of obtaining eye care appointments and appointment wait times for those with Medicaid vs those with private insurance. DESIGN, SETTING, AND PARTICIPANTS In this prospective, cohort study conducted from January 1, 2017, to July 1, 2017, researchers made telephone calls to a randomly selected sample of vision care professionals in Michigan and Maryland stratified by neighborhood (urban vs rural) and professional type (ophthalmologist vs optometrist) to request the first available appointment. Appointments were sought for an adult needing a diabetic eye examination and a child requesting a routine eye examination for a failed vision screening. Researchers called each practice twice, once requesting an appointment for a patient with Medicaid and the other time for a patient with Blue Cross Blue Shield (BCBS) insurance, and asked whether the insurance was accepted and, if so, when the earliest available appointment could be scheduled. MAIN OUTCOMES AND MEASURES Rate of successfully made appointments and mean wait time for the first available appointment. RESULTS A total of 603 telephone calls were made to 330 eye care professionals (414 calls [68.7%] to male and 189 calls [31.3%] to female eye care professionals). The sample consisted of ophthalmologists (303 [50.2%]) and optometrists (300 [49.8%]) located in Maryland (322 [53.4%]) and Michigan (281 [46.6%]). The rates of successfully obtaining appointments among callers were 61.5% (95% CI, 56.0%-67.0%) for adults with Medicaid and 79.3% (95% CI, 74.7%-83.9%) for adults with BCBS (P < .001) and 45.4% (95% CI, 39.8%-51.0%) for children with Medicaid and 62.5% (95% CI, 57.1%-68.0%) for children with BCBS (P < .001). Mean wait time did not vary significantly between the BCBS and Medicaid groups for both adults and children. Adults with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (odds ratio [OR], 0.41; 95% CI, 0.28-0.59; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 2.40; 95% CI, 1.49-3.87; P < .001) or with an optometrist vs an ophthalmologist (OR, 1.91; 95% CI, 1.31-2.79; P < .001). Children with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (OR, 0.41; 95% CI, 0.28-0.60; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 1.68; 95% CI, 1.04-2.73; P = .03) or with an optometrist vs an ophthalmologist (OR, 8.00; 95% CI, 5.37-11.90; P < .001). CONCLUSIONS AND RELEVANCE Callers were less successful in trying to obtain eye care appointments with Medicaid than with BCBS, suggesting a disparity in access to eye care based on insurance status, although confounding factors may have contributed to this finding. Improving access to eye care professionals for those with Medicaid may improve health outcomes and decrease health care spending in the long term.

Original languageEnglish (US)
Pages (from-to)622-629
Number of pages8
JournalJAMA Ophthalmology
Volume136
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Blue Cross Blue Shield Insurance Plans
Medicaid
Health Insurance
Appointments and Schedules
Delivery of Health Care
Odds Ratio
Insurance
Telephone
Vision Screening
Research Personnel
Insurance Coverage
Poverty

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Comparison of access to eye care appointments between patients with medicaid and those with private health care insurance. / Lee, Yoon H.; Chen, Andrew X.; Varadaraj, Varshini; Hong, Gloria H.; Chen, Yimin; Friedman, David S; Stein, Joshua D.; Kourgialis, Nicholas; Ehrlich, Joshua R.

In: JAMA Ophthalmology, Vol. 136, No. 6, 01.06.2018, p. 622-629.

Research output: Contribution to journalArticle

Lee, Yoon H. ; Chen, Andrew X. ; Varadaraj, Varshini ; Hong, Gloria H. ; Chen, Yimin ; Friedman, David S ; Stein, Joshua D. ; Kourgialis, Nicholas ; Ehrlich, Joshua R. / Comparison of access to eye care appointments between patients with medicaid and those with private health care insurance. In: JAMA Ophthalmology. 2018 ; Vol. 136, No. 6. pp. 622-629.
@article{a0d183a77f454b7c9200f57ce8877abf,
title = "Comparison of access to eye care appointments between patients with medicaid and those with private health care insurance",
abstract = "IMPORTANCE Although low-income populations have more eye problems, whether they face greater difficulty obtaining eye care appointments is unknown. OBJECTIVE To compare rates of obtaining eye care appointments and appointment wait times for those with Medicaid vs those with private insurance. DESIGN, SETTING, AND PARTICIPANTS In this prospective, cohort study conducted from January 1, 2017, to July 1, 2017, researchers made telephone calls to a randomly selected sample of vision care professionals in Michigan and Maryland stratified by neighborhood (urban vs rural) and professional type (ophthalmologist vs optometrist) to request the first available appointment. Appointments were sought for an adult needing a diabetic eye examination and a child requesting a routine eye examination for a failed vision screening. Researchers called each practice twice, once requesting an appointment for a patient with Medicaid and the other time for a patient with Blue Cross Blue Shield (BCBS) insurance, and asked whether the insurance was accepted and, if so, when the earliest available appointment could be scheduled. MAIN OUTCOMES AND MEASURES Rate of successfully made appointments and mean wait time for the first available appointment. RESULTS A total of 603 telephone calls were made to 330 eye care professionals (414 calls [68.7{\%}] to male and 189 calls [31.3{\%}] to female eye care professionals). The sample consisted of ophthalmologists (303 [50.2{\%}]) and optometrists (300 [49.8{\%}]) located in Maryland (322 [53.4{\%}]) and Michigan (281 [46.6{\%}]). The rates of successfully obtaining appointments among callers were 61.5{\%} (95{\%} CI, 56.0{\%}-67.0{\%}) for adults with Medicaid and 79.3{\%} (95{\%} CI, 74.7{\%}-83.9{\%}) for adults with BCBS (P < .001) and 45.4{\%} (95{\%} CI, 39.8{\%}-51.0{\%}) for children with Medicaid and 62.5{\%} (95{\%} CI, 57.1{\%}-68.0{\%}) for children with BCBS (P < .001). Mean wait time did not vary significantly between the BCBS and Medicaid groups for both adults and children. Adults with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (odds ratio [OR], 0.41; 95{\%} CI, 0.28-0.59; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 2.40; 95{\%} CI, 1.49-3.87; P < .001) or with an optometrist vs an ophthalmologist (OR, 1.91; 95{\%} CI, 1.31-2.79; P < .001). Children with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (OR, 0.41; 95{\%} CI, 0.28-0.60; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 1.68; 95{\%} CI, 1.04-2.73; P = .03) or with an optometrist vs an ophthalmologist (OR, 8.00; 95{\%} CI, 5.37-11.90; P < .001). CONCLUSIONS AND RELEVANCE Callers were less successful in trying to obtain eye care appointments with Medicaid than with BCBS, suggesting a disparity in access to eye care based on insurance status, although confounding factors may have contributed to this finding. Improving access to eye care professionals for those with Medicaid may improve health outcomes and decrease health care spending in the long term.",
author = "Lee, {Yoon H.} and Chen, {Andrew X.} and Varshini Varadaraj and Hong, {Gloria H.} and Yimin Chen and Friedman, {David S} and Stein, {Joshua D.} and Nicholas Kourgialis and Ehrlich, {Joshua R.}",
year = "2018",
month = "6",
day = "1",
doi = "10.1001/jamaophthalmol.2018.0813",
language = "English (US)",
volume = "136",
pages = "622--629",
journal = "JAMA Ophthalmology",
issn = "2168-6165",
publisher = "American Medical Association",
number = "6",

}

TY - JOUR

T1 - Comparison of access to eye care appointments between patients with medicaid and those with private health care insurance

AU - Lee, Yoon H.

AU - Chen, Andrew X.

AU - Varadaraj, Varshini

AU - Hong, Gloria H.

AU - Chen, Yimin

AU - Friedman, David S

AU - Stein, Joshua D.

AU - Kourgialis, Nicholas

AU - Ehrlich, Joshua R.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - IMPORTANCE Although low-income populations have more eye problems, whether they face greater difficulty obtaining eye care appointments is unknown. OBJECTIVE To compare rates of obtaining eye care appointments and appointment wait times for those with Medicaid vs those with private insurance. DESIGN, SETTING, AND PARTICIPANTS In this prospective, cohort study conducted from January 1, 2017, to July 1, 2017, researchers made telephone calls to a randomly selected sample of vision care professionals in Michigan and Maryland stratified by neighborhood (urban vs rural) and professional type (ophthalmologist vs optometrist) to request the first available appointment. Appointments were sought for an adult needing a diabetic eye examination and a child requesting a routine eye examination for a failed vision screening. Researchers called each practice twice, once requesting an appointment for a patient with Medicaid and the other time for a patient with Blue Cross Blue Shield (BCBS) insurance, and asked whether the insurance was accepted and, if so, when the earliest available appointment could be scheduled. MAIN OUTCOMES AND MEASURES Rate of successfully made appointments and mean wait time for the first available appointment. RESULTS A total of 603 telephone calls were made to 330 eye care professionals (414 calls [68.7%] to male and 189 calls [31.3%] to female eye care professionals). The sample consisted of ophthalmologists (303 [50.2%]) and optometrists (300 [49.8%]) located in Maryland (322 [53.4%]) and Michigan (281 [46.6%]). The rates of successfully obtaining appointments among callers were 61.5% (95% CI, 56.0%-67.0%) for adults with Medicaid and 79.3% (95% CI, 74.7%-83.9%) for adults with BCBS (P < .001) and 45.4% (95% CI, 39.8%-51.0%) for children with Medicaid and 62.5% (95% CI, 57.1%-68.0%) for children with BCBS (P < .001). Mean wait time did not vary significantly between the BCBS and Medicaid groups for both adults and children. Adults with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (odds ratio [OR], 0.41; 95% CI, 0.28-0.59; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 2.40; 95% CI, 1.49-3.87; P < .001) or with an optometrist vs an ophthalmologist (OR, 1.91; 95% CI, 1.31-2.79; P < .001). Children with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (OR, 0.41; 95% CI, 0.28-0.60; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 1.68; 95% CI, 1.04-2.73; P = .03) or with an optometrist vs an ophthalmologist (OR, 8.00; 95% CI, 5.37-11.90; P < .001). CONCLUSIONS AND RELEVANCE Callers were less successful in trying to obtain eye care appointments with Medicaid than with BCBS, suggesting a disparity in access to eye care based on insurance status, although confounding factors may have contributed to this finding. Improving access to eye care professionals for those with Medicaid may improve health outcomes and decrease health care spending in the long term.

AB - IMPORTANCE Although low-income populations have more eye problems, whether they face greater difficulty obtaining eye care appointments is unknown. OBJECTIVE To compare rates of obtaining eye care appointments and appointment wait times for those with Medicaid vs those with private insurance. DESIGN, SETTING, AND PARTICIPANTS In this prospective, cohort study conducted from January 1, 2017, to July 1, 2017, researchers made telephone calls to a randomly selected sample of vision care professionals in Michigan and Maryland stratified by neighborhood (urban vs rural) and professional type (ophthalmologist vs optometrist) to request the first available appointment. Appointments were sought for an adult needing a diabetic eye examination and a child requesting a routine eye examination for a failed vision screening. Researchers called each practice twice, once requesting an appointment for a patient with Medicaid and the other time for a patient with Blue Cross Blue Shield (BCBS) insurance, and asked whether the insurance was accepted and, if so, when the earliest available appointment could be scheduled. MAIN OUTCOMES AND MEASURES Rate of successfully made appointments and mean wait time for the first available appointment. RESULTS A total of 603 telephone calls were made to 330 eye care professionals (414 calls [68.7%] to male and 189 calls [31.3%] to female eye care professionals). The sample consisted of ophthalmologists (303 [50.2%]) and optometrists (300 [49.8%]) located in Maryland (322 [53.4%]) and Michigan (281 [46.6%]). The rates of successfully obtaining appointments among callers were 61.5% (95% CI, 56.0%-67.0%) for adults with Medicaid and 79.3% (95% CI, 74.7%-83.9%) for adults with BCBS (P < .001) and 45.4% (95% CI, 39.8%-51.0%) for children with Medicaid and 62.5% (95% CI, 57.1%-68.0%) for children with BCBS (P < .001). Mean wait time did not vary significantly between the BCBS and Medicaid groups for both adults and children. Adults with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (odds ratio [OR], 0.41; 95% CI, 0.28-0.59; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 2.40; 95% CI, 1.49-3.87; P < .001) or with an optometrist vs an ophthalmologist (OR, 1.91; 95% CI, 1.31-2.79; P < .001). Children with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (OR, 0.41; 95% CI, 0.28-0.60; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 1.68; 95% CI, 1.04-2.73; P = .03) or with an optometrist vs an ophthalmologist (OR, 8.00; 95% CI, 5.37-11.90; P < .001). CONCLUSIONS AND RELEVANCE Callers were less successful in trying to obtain eye care appointments with Medicaid than with BCBS, suggesting a disparity in access to eye care based on insurance status, although confounding factors may have contributed to this finding. Improving access to eye care professionals for those with Medicaid may improve health outcomes and decrease health care spending in the long term.

UR - http://www.scopus.com/inward/record.url?scp=85048790120&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048790120&partnerID=8YFLogxK

U2 - 10.1001/jamaophthalmol.2018.0813

DO - 10.1001/jamaophthalmol.2018.0813

M3 - Article

VL - 136

SP - 622

EP - 629

JO - JAMA Ophthalmology

JF - JAMA Ophthalmology

SN - 2168-6165

IS - 6

ER -