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

项目摘要/摘要 视力问题在老年人中很普遍，约92%的医疗保险参保人年龄在65岁及以上 使用视力矫正，39%的使用视力矫正的联邦医疗保险参保人报告甚至有视力障碍 戴着眼镜。视力障碍与发病率和死亡率的增加有关，包括 增加摔倒和髋部骨折的风险。虽然大多数按服务收费的联邦医疗保险参保人没有覆盖范围 对于常规的眼睛检查和眼镜，一些低收入的联邦医疗保险参与者有全面的视力保险 如果他们有资格享受全额医疗补助福利(“双重资格”)，并且居住在拥有医疗补助计划的州， 涵盖视觉服务。这项建议的目标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部护理可获得性和跌倒相关结局的影响 在2000-2019年期间符合双重资格的人中。中心假设是视觉服务的覆盖率将会增加 眼睛护理检查，并通过提高视力来降低跌倒的风险。核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 眼睛护理和视力，包括眼睛护理访问，未满足的眼镜需求，日常眼科自掏腰包支出 护理，自我报告视力障碍，视力导致的功能限制，以及基于联邦医疗保险索赔的 过去一年对青光眼、白内障和老年性黄斑变性的治疗；2)检查疗效 医疗补助视力对跌倒相关结果的益处，包括自我报告的跌倒、跌倒相关的伤害和活动 因害怕跌倒而造成的限制和跌倒的行政治疗措施；以及3)评估 医疗补助视力受益于性别、种族和民族、糖尿病诊断和阿尔茨海默病的影响， 相关的痴呆症和记忆力丧失。本申请中提出的研究具有创新性，因为它将 使用几个互补的数据源，包括链接的调查和行政索赔数据，以检查 眼部护理可获得性和跌倒相关结果的衡量标准，汇编一个全面的医疗补助视力数据库 超过20年的福利政策将与研究人员分享，结合准试验性 使用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。这项拟议的研究具有重要意义，因为 65岁及以上的成年人预计在未来40年内将增加一倍以上。相应地， 在此期间，视力问题和伤害性跌倒的患病率可能会显著增加。这个 拟议的AIMS将首次估计医疗补助视力福利对眼睛护理机会的影响，并 符合双重资格的人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、 及时的、与政策相关的证据，说明老年人和 公共医疗保险的作用。

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.