Impact of routine eye care coverage on access to eye care and fall-related outcomes among low-income Medicare enrollees

项目总结/摘要 视力问题在老年人中普遍存在，约92%的医疗保险注册人年龄在65岁及以上 使用视力矫正，39%的使用视力矫正的医疗保险登记者报告说， 戴着眼镜视力损害与发病率和死亡率的增加有关，包括 增加福尔斯和髋部骨折的风险。虽然大多数按服务收费的医疗保险登记者没有保险， 对于常规的眼科检查和眼镜，一些低收入的医疗保险注册者有全面的视力保险 如果他们有资格获得全部医疗补助福利（“双重杀戮”），并居住在一个有医疗补助计划的州， 包括视力服务。本提案的目的是使用准实验方法来估计 常规眼科检查和眼镜的医疗补助覆盖范围对眼科护理获得和跌倒相关结果的影响 在2000年至2019年的双杀中。中心假设是视力服务的覆盖率将增加 眼睛护理就诊，通过改善视力来降低跌倒的风险。中心假设将通过以下方式进行检验： 追求三个具体目标：1）检查医疗补助视力福利对获得医疗服务的措施的影响。 眼睛护理和视力，包括眼睛护理访视、未满足的眼镜需求、日常眼科自付支出 护理、自我报告的视力问题、视力导致的功能限制以及基于医疗保险索赔的措施 青光眼、白内障和年龄相关性黄斑变性的过去一年治疗; 2）检查效果 的医疗补助视力福利对跌倒相关的结果，包括自我报告的福尔斯，跌倒相关的伤害，和活动 由于害怕跌倒而导致的限制和福尔斯治疗的行政措施;以及3）评估 按性别、种族和民族、糖尿病诊断和阿尔茨海默病分类的医疗补助视力福利的影响， 相关的痴呆症和记忆丧失本申请中提出的研究是创新的，因为它将 使用多个补充数据源，包括关联调查和行政索赔数据， 眼保健服务和跌倒相关结果的措施，编制医疗补助视力的综合数据库， 受益政策超过20年的时间与研究人员分享，联合收割机结合准实验 采用9年的个人纵向数据面板，并应用新开发的方法来解决 国家政策变化的时间变化。这项研究意义重大，因为 65岁及以上的成年人预计在今后40年将增加一倍以上。相应地 在此期间，视力问题和伤害性福尔斯跌倒的发生率可能显著增加。的 拟议的目标将产生医疗补助视力福利对眼科护理服务的影响的第一个估计， 双杀中与跌倒相关的结果。这项研究对公共卫生的影响将是提供关键的， 及时和政策相关的证据，说明老年人获得更多视力保健的影响， 公共健康保险的作用。

PROJECT SUMMARY/ABSTRACT Vision problems are prevalent among older adults, with about 92% of Medicare enrollees ages 65 and older using vision correction, and 39% of Medicare enrollees who use vision correction reporting trouble seeing even with eyeglasses. Visual impairment is associated with increased morbidity and mortality, including an increased risk of falls and hip fractures. While most fee-for-service Medicare enrollees do not have coverage for routine eye exams and glasses, some low-income Medicare enrollees have comprehensive vision coverage if they qualify for full Medicaid benefits (“dual eligibles”) and reside in a state with a Medicaid program that covers vision services. The objective of this proposal is to use quasi-experimental methods to estimate the effect of Medicaid coverage of routine eye exams and glasses on eye care access and fall-related outcomes among dual eligibles during 2000-2019. The central hypothesis is that coverage of vision services will increase eye care visits and reduce the risk of falling by improving vision. The central hypothesis will be tested by pursuing three specific aims: 1) to examine the effects of Medicaid vision benefits on measures of access to eye care and vision including eye care visits, unmet needs for glasses, out-of-pocket spending on routine eye care, self-reported trouble seeing, functional limitations due to vision, and Medicare claims-based measures of past-year treatment for glaucoma, cataracts, and age-related macular degeneration; 2) to examine the effects of Medicaid vision benefits on fall-related outcomes including self-reported falls, fall-related injuries, and activity limitations due to fear of falling and administrative measures of treatment for falls; and 3) to evaluate the effects of Medicaid vision benefits by sex, race and ethnicity, diabetes diagnosis, and by Alzheimer’s disease, related dementias, and memory loss. The research proposed in this application is innovative because it will use several complementary data sources including linked survey and administrative claims data to examine measures of eye care access and fall-related outcomes, compile a comprehensive database of Medicaid vision benefit policies over a more than 20 year period to be shared with researchers, combine a quasi-experimental approach with a 9 year panel of individual longitudinal data, and apply newly developed methods to address variation in the timing of state policy changes. The proposed research is significant because the number of adults ages 65 and older is projected to more than double over the next 40 years. Correspondingly, the prevalence of vision problems and injurious falls is likely to increase significantly over this period. The proposed aims will produce the first estimates of the effects of Medicaid vision benefits on eye care access and fall-related outcomes among dual eligibles. The public health impact of this research will be to provide critical, timely, and policy relevant evidence on the effects of increased access to vision care among older adults and the role of public health insurance.