Health insurance and eye care
Reported Eye Care Utilization and Health Insurance Status Among US Adults
By David J. Lee, PhD; Byron L. Lam, MD; Sahel Arora, BS; Kristopher L. Arheart, EdD; Kathryn E. McCollister, PhD; D. Diane Zheng, MS; Sharon L. Christ, MS; Evelyn P. Davila, MPH
Archives of Ophthalmology
March 2009
The association between low eye care utilization rates and lack of, or inconsistent, health insurance coverage, even after adjustment for income and educational attainment, suggests that overall ocular health care access would be enhanced if progress is made toward securing coverage for the 46.6 million Americans who do not currently have health insurance. Our findings have also identified troubling gaps in eye care utilization among adults with health insurance coverage. Adults who reported an interruption in health insurance coverage in the 12 months prior to the interview were less likely to report a visit to an ocular health care provider than were those who were consistently insured. In our analyses, 3.8% or an estimated 7.8 million US community-residing adults annually reported such a coverage gap in the past 12 months.
We also found that adults who reported concurrent private and public health care coverage were generally more likely to report an ocular health care visit in the preceding 12 months than were adults who had private insurance only, even after adjustment for level of visual impairment, sex, and educational attainment. The NHIS (National Health Interview Survey) did not assess whether ocular care was included as part of the participants’ insurance coverage. It is nevertheless possible that public coverage filled in some of the well-known gaps in ocular health care coverage of many of the private health care plans offered in the United States. For example, Medicare and Medicaid typically include basic eye care services, such as annual eye examinations. Our findings point to the need for addressing the coverage limitations for ocular care in private insurance plans as well as addressing the broader need for health insurance for all Americans.
http://archopht.ama-assn.org/cgi/content/full/127/3/303
And…
Is Universal Vision Care Coverage the Best Way to Get People to See Their Eye Care Providers?
By Steven M. Kymes, PhD, MHA; Kevin D. Frick, PhD
Archives of Ophthalmology
March, 2009
In this issue of Archives, Lee et al present a report on the relationship between insurance coverage and recommended visits to ophthalmologists or optometrists. They find several important predictors of such visits, one of which is health insurance coverage. In their conclusion, they call upon vision care professionals to assume a role as advocates for universal health insurance coverage, in particular vision care insurance, for all Americans. They assert that providing universal vision care coverage would insure that financial resources are no longer a barrier for those seeking access to a vision care provider. However, we must also consider whether this would indeed be the most effective method to achieve the social goal of increased use of vision care services.
It is important to recognize that if we as a society provide universal health insurance coverage, it would not come without a cost.
(The authors then provide a highly dubious analysis that purports to show that “our health care system would pay $435 in annual insurance coverage for each new person who is motivated to seek vision care.”)
There is no doubt that providing preventive vision care services is important, as is providing care for those with chronic eye conditions. But before taking this step, we should ask if the benefit of spending $435 to motivate someone to seek an annual visit to their eye care provider outweighs the cost. Answering the question would involve a rigorous evaluation of the benefits of the ocular examination. What is the probability that an undiagnosed ocular condition will be found? What is the benefit of identifying that condition in reducing future health care costs? What is the benefit of regular examinations of people with chronic eye conditions in adjusting treatment strategies, insuring compliance, and making referrals for specialized care? By asking such questions, we can determine the balance between costs and benefits. The results would help policymakers and physicians to determine if providing insurance coverage would indeed be the best approach to promoting vision care or if other methods of improving access should be considered.
Lee and colleagues have made an important contribution to this growing literature by examining barriers to vision care. However, the principles of scientific inquiry should not be shortchanged simply because we are debating a policy question rather than a biochemical one. The vision care community has an obligation to fully consider alternative solutions and their consequences in seeking ways to remove barriers to vision care.
http://archopht.ama-assn.org/cgi/content/full/127/3/335
Comment:
By Don McCanne, MD
One single word, whether it’s “and” or “or,” can make such a difference in health policy.
This study confirms that what we already know about the importance of insurance in improving access and utilization of health care also applies specifically to eye care. Individuals with insurance have higher rates of access and utilization of eye care than those who are uninsured and those have have interruptions of their insurance coverage.
This study also indicates that those who have public coverage in addition to private coverage have significantly higher utilization rates than those who have private coverage alone. Public coverage seems to help fill in the gaps in private coverage.
The obvious policy conclusion is that everyone should be covered with health insurance that has adequate benefits, including eye care. Quite simple.
Apparently that is not the conclusion of the authors of the commentary on this study that appears in the same issue of Archives of Ophthalmology, a publication of the American Medical Association. To improve access to vision care, they do not suggest removing one of the more important barriers to care by providing everyone with health insurance. Without stating it explicitly, they imply that their estimate of a $435 premium (a straw man estimate) is too high of a price to pay for eye coverage. Instead they recommend the consideration of insurance coverage “or” the consideration of other methods of improving access. There is that all important “or” word, when most members of the policy community would have used “and.”
Just to indicate that this wasn’t simply a slip of words, they reinforce their view by stating that “the vision care community has an obligation to fully consider alternative solutions,” where “alternative” is another “or” word.
This study is a valuable contribution to the health policy literature, indicating, once again, that we must repair our health care financing system so that everyone has affordable access to all necessary health care. It is sad that there are those who continue to use garbage policy pseudo-science to battle the champions of health care justice. And it is especially tragic that they have continued to win.