title: Need for eye care among older adults with diabetes mellitus in fee-for-service and managed Medicare.
abstract: 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.
authors.affiliation: Department of Medicine, Jules Stein Eye Institute, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, USA. abrown@mednet.ucla.edu
authors.forename: Arleen F
authors.initials: AF
authors.lastname: Brown
authors.forename: Luohua
authors.initials: L
authors.lastname: Jiang
authors.forename: Donald S
authors.initials: DS
authors.lastname: Fong
authors.forename: Peter R
authors.initials: PR
authors.lastname: Gutierrez
authors.forename: Anne L
authors.initials: AL
authors.lastname: Coleman
authors.forename: Paul P
authors.initials: PP
authors.lastname: Lee
authors.forename: John
authors.initials: J
authors.lastname: Adams
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
mesh_terms: D000368:Aged; D002386:Cataract / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000453:epidemiology; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D005901:Glaucoma / Q000453:epidemiology; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*