Managed care cuts cataract surgeries by half
Managed care is slowing the number of cataract procedures performed annually. In a recent study, Medicare patients enrolled in managed health plans were half as likely to undergo cataract extractions than similar patients covered under fee-for-service plans, according to researchers at the Veterans Affairs Medical Center in Los Angeles.
The study, which was published in the June 10 issue of JAMA, speculated that financial incentives may be at fault. Capitated primary care physicians were likely to restrict referrals to specialists, which resulted in fewer procedures performed.1
In contrast, fee-for-service patients were able to freely self-refer to ophthalmologists. In those cases, cataract extractions occurred twice as often as the those involving the managed care group. The study, however, found that prepaid health plans more than likely delayed rather than denied the procedure.
The study surveyed 43,387 staff model health maintenance organizations, 19,050 physician practices, and more than 47,000 fee-for-service patients.
Reference
1. Goldzweig CL. Variations in cataract extraction rates in Medicare prepaid and fee-for-service settings. JAMA 1997; 277:1,765-1,768.
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