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Health Care for the Elderly

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More elderly patients are receiving eye care, but Medicare costs have remained constant

A greater proportion of elderly patients insured by Medicare fee-for-service (FFS) plans received eye care in 1998 than in 1991. However, overall Medicare eye care costs did not increase during the 8-year period, since the amount Medicare reimbursed for eye care services per beneficiary (allowable charges) declined.

The proportion of beneficiaries receiving eye care increased from 41.4 percent to 48.1 percent over the 8-year period. Yet physician charges attributable to eye care decreased from 12.5 percent to 10.4 percent, with annual inflation-adjusted charges per beneficiary decreasing 25 percent from $235 to $176 (1998 dollars), according to a study supported by the Agency for Healthcare Research and Quality (Contract 290-95-2002).

In each of the 8 years, 60 percent of eye care involved eye exams and other evaluation and management services. Medicare fees increased for these services, but they decreased for cataract and other surgical procedures, explain Leon B. Ellwein, Ph.D., of the National Eye Institute, and Carol J. Urato, M.A., of Health Economics Research, Inc. They reviewed fee-for-service physician claims from a 5 percent sample of Medicare beneficiaries 65 years of age and older. The researchers compared use of eye care services and procedures, frequency of ocular diagnoses, and allowed charges for each year from 1991 through 1998.

Eye care increased for most of the 16 diagnostic categories. Cataract-related cases were particularly common, with an 18 percent increase in cases between 1991 and 1997 (from 23 to 28 per 100 beneficiaries). Glaucoma cases increased nearly 40 percent from 7 per 100 beneficiaries in 1991 to 10 per 100 beneficiaries in 1998, followed by retinal diseases, which had a 47 percent increase. Much of the decline in the cost of eye care was associated with a decrease in cataract-related charges. Retinal disease claims accounted for 15.4 percent of eye care charges in 1998, up from 10.7 percent in 1991. Glaucoma claims accounted for nearly 10 percent of eye care charges each year.

See "Use of eye care and associated charges among the Medicare population," by Drs. Ellwein and Urato, in the June 2002 Archives of Ophthalmology 120, pp. 804-811.

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