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Zachary Ryan Richardson, Gary Oliver, Ann Ostrovsky; Impact of the Affordable Health Care Act on No-Show Rates and Demographics of Patients Presenting for Eye Care in an Underserved Inner City Population.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2136.
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© ARVO (1962-2015); The Authors (2016-present)
Patients in underserved areas face substantial barriers to access to health care, especially due to lack of insurance and as a result of high no-show rates. In this study we set out to determine if the implementation of the Affordable Health Care Act (AHCA) affected no-show rates and access to eye care services in an underserved inner city population.
A retrospective cohort study compared the demographics (age, sex, gender, self described ethnicity) and no-show rates of patients seen at an inner city public hospital eye clinic, between 2 time periods: 1/2012-12/2013 (pre-AHCA) and 1/2014-9/2014 (post-AHCA). Pre- and post-AHCA demographics and no show rates were compared using t-test. The changes in payer mix (including self-pay, commercial, medicaid, medicare, HHC insurances), pre- and post- AHCA, were analyzed using Chi Square analysis.
A total of 7582 patients were seen in the pre-AHCA time frame, and 7201 patients were seen post AHCA. The average patient age was 53±4.0 years pre-AHCA and 54±4.2 years post-AHCA (p>0.05). The gender distribution of patients seen pre-AHCA (Females 61.3%, Males 38.7%) was similar to those seen post-AHCA (females 60.4%, males 39.7%). In both the pre- and post-AHCA period, Hispanic patients comprised the majority of the clinic population (48.3% vs 46.1%; p=0.12). African Americans were the second majority (27.9% vs 27.7%; p=0.86). Significantly more Caucasians (7.5% vs 9.4%; p=0.0001) and significantly less Hispanic Blacks (3.68% vs 3.04%; p= 0.04) were seen post-AHCA. The changes in payer mix for pre- and post-AHCA were as follows: self-pay (0.9 vs 1.7%; p=0.00; commercial insurance (3.8% vs 4.5%; p=0.026), HHC Options (39.5% vs 38.5% ;p=0.23), Medicaid managed care (28.7% vs 28.1%; p=0.42), Medicare managed care (14.4% vs 14.6%; p=0.77), Medicare (7.2% vs 7.0%; p=0.65), and Medicaid (3.4% vs 3.9%; p=0.97). The no-show rates for pre- and post-AHCA were similar, 39±8.8% and 42±10.4% (p=0.7796).
With the passage of AHCA, more Caucasian patients and less Hispanic Black patients sought eye care. As expected, the proportion of commercial insurances presenting to the hospital increased, but surprisingly the proportion of self-pay patients increased. No-show rates have not been impacted by the AHCA and remain high, presenting a significant challenge to access to care.
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