title: A comparison of self-reported utilization of ophthalmic care for diabetes in managed care versus fee-for-service.
abstract: OBJECTIVE
  To assess the association between structural factors in the health care delivery system and self-reported utilization of ophthalmic services by patients with diabetes in the Medical Outcomes Study (MOS).
  
  
  METHODS
  Self-reported utilization of ophthalmic services within the 6 months preceding enrollment into the MOS among 522 of 567 individuals with diabetes in the MOS longitudinal panel was measured. Use of eye care services was regressed (logistic model) on patient demographics, geographic location, physician specialty, type of practice, and finance plan (prepaid or fee-for-service).
  
  
  RESULTS
  None of the variables was significantly associated with a higher or lower likelihood of having used ophthalmic services in the preceding 6 months. Thus, no difference between prepaid or fee-for-service plans or among solo practice, large multispecialty groups, or HMOs were identified. Having seen an internist, family practitioner, or diabetes specialist for diabetes care was not related to use of ophthalmic services.
  
  
  CONCLUSIONS
  Despite a presumed greater interest in preventive health, prepaid health plans were no more or less likely than the fee-for-service sector to have patients with diabetes reporting an eye examination within the prior 6 months. Thus, steps to improve the rate of eye examinations of diabetics may need to focus beyond the structural elements of the health care delivery system.
authors.affiliation: Doheny Eye Institute, University of Southern California School of Medicine, Los Angeles, USA.
authors.forename: P P
authors.initials: PP
authors.lastname: Lee
authors.forename: L S
authors.initials: LS
authors.lastname: Meredith
authors.forename: S M
authors.initials: SM
authors.lastname: Whitcup
authors.forename: K
authors.initials: K
authors.lastname: Spritzer
authors.forename: R D
authors.initials: RD
authors.lastname: Hays
mesh_terms: D003920:Diabetes Mellitus / Q000628:therapy*; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000517:prevention & control; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008875:Middle Aged; D009885:Ophthalmology / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D012650:Self Disclosure; D014481:United States; D015351:Vision Screening / Q000706:statistics & numerical data*