Abstract
Purpose :
To evaluate the impact of the Affordable Health Care Act (AHCA) two years after its inception on no-show rates and access to eye care services in an underserved inner city population.
Methods :
A retrospective cohort study comparing the no-show rates and demographics (age, gender, ethnicity) of patients presenting to an inner city public hospital eye clinic from January 1 through December 30, 2013 (pre-AHCA) with January 1, 2014 through December 30, 2015 (post-AHCA). Demographics were compared by T-test, no-show rates were compared using ANOVA, and payer mix changes were analyzed using the Chi-squared test.
Results :
7582 patients were seen in the pre-AHCA group and 14,981 in the post-AHCA. Age and gender were similar. Fewer Hispanics (51 vs 47%; p<0.001) and more Caucasians (7.8 vs 8.6%; p=0.003) presented post-AHCA. The changes in payer mix for pre- and post-AHCA were all significant except for with Medicaid: HHC options (40 vs 37%; p=0.006), MCP (46 vs 47.6%; p<0.001), Medicare (8 vs 6.8%; p=0.004), Medicaid (4.5 vs 4.4%; p=0.95), self-pay (1.3 vs 2%; p<0.001). The no-show rates for pre- and post-AHCA were 39±8.8% and 45±9% (p=0.05).
Conclusions :
Two years after the enactment of the AHCA, more Caucasian patients and fewer Hispanic patients sought eye care. As expected, the proportion of managed care plans presenting to the hospital increased, but the proportion of self-pay patients also increased. Surprisingly, no-show rates have increased post-AHCA, continuing to present a significant challenge to access to care.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.