Individuals aged 65 and older with diabetes are at high risk for eye diseases, including cataract, glaucoma and diabetic retinopathy (an eye disease in the retina that can result in seriously distorted or blurred vision), according to background information in the article. Although previous studies have shown that appropriate ophthalmic care can reduce the progression of eye disease and reduce or reverse visual disability, eye care for older persons with diabetes may not be adequate. The authors suggest that managed care has the potential to enhance the coordination of primary and specialty care and increase access to appropriate eye care for older individuals with diabetes. In some states, including California, almost half of all Medicare beneficiaries in managed care were enrolled in for-profit Medicare + Choice plans in 1999.
Arleen F. Brown, M.D., Ph.D., of the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues interviewed Medicare beneficiaries in Los Angeles County with diabetes about their medical history and health care and eye care service use. Ophthalmologic examinations were performed to assess need for eye care services. The researchers also evaluated whether the rates of need for eye care differed in fee-for-service Medicare and the for-profit Medicare + Choice network model (MC) managed care plan. The need for eye care within six months of the eye examination was based on American Academy of Ophthalmology guidelines and clinical judgment.
Three-hundred-eleven patients with managed care health insurance and 107 with fee-for-service health insurance co
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