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PEDIATRICS Vol. 113 No. 3 March 2004, pp. e190-e196

ELECTRONIC ARTICLE

Patterns of Vision Care Among Medicaid-Enrolled Children

Alex R. Kemper, MD, MPH, Lisa M. Cohn, MS and Kevin J. Dombkowski, DrPH

From the Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan

Objective. To describe patterns of vision care among Medicaid-enrolled children.

Methods. We evaluated claims data over a 1-year period among children who were 18 years and younger, living in Michigan, and continuously enrolled in Medicaid but did not have a complex medical condition or were disabled. For this study, vision care comprised eye care services provided by optometrists or ophthalmologists and lens services, including dispensing and fitting of corrective lenses.

Results. Children in rural counties had increased odds of receiving eye care (odds ratio [OR]: 1.24) or lens services (OR: 1.22) compared with those in urban counties. In urban counties, non-Hispanic white children had greater odds than Hispanic or nonwhite children to have eye care (OR: 1.37) and lens services (OR: 1.37). An increasing supply of eye care professionals per population within a county was associated with decreased vision care in urban counties and slightly increased eye care and no changes in lens services in rural counties. Urban children who received mostly fee-for-service Medicaid had greater odds of receiving vision care than those with longer periods of managed care. Rural children who received mostly fee-for-service Medicaid had greater odds of eye care but similar odds of lens services. Regardless of urban/rural status, girls had increased odds of receiving eye care (OR: 1.24 for urban, 1.20 for rural) and lens services (OR: 1.36 for urban, 1.24 for rural).

Conclusions. Patterns emerged that suggest underutilization or overutilization of vision care services. Such differences may have an impact on the development of children or waste limited health care resources.

Key Words: vision • Medicaid • optometry • ophthalmology • rural health services • urban health services

Abbreviations: OR, odds ratio • CI, confidence interval

Received for publication Sep 15, 2003; Accepted Oct 21, 2003.




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