Abstract
Purpose :
To investigate the impact of the affordable care act (ACA) on nationwide eye-related emergency department (ED) utilization
Methods :
Nationally representative data from the US Nationwide Emergency Department Sample (NEDS) were used to analyze eye-related ED visits before (2010-2013) and after (2014-2017) the ACA was mandated. The primary outcome was to compare the nationwide and regional incidence of eye-related ED visits per 100,000 US population before and after the ACA was mandated. Secondary outcomes measures included change in payor status, relative proportion of urgent versus non-urgent eye-related ED visits and charges per ED visit.
Results :
A total of 16,808,343 eye-related ED visits occurred in the United States during the study period from 2010-2017. Of these, 8,088,203 ED visits occurred before the ACA was mandated (2010-2013) and 8,720,766 ED visits occurred after the ACA was mandated (2014-2017). The median age of individuals presenting to the ED with eye-related problems was 30 years and 53.4% of them were male. After the ACA was mandated in 2014, there was an initial decline in incidence of eye-related ED visits from 652.4 per 100,000 in 2013 to 593.0 per 100,000 in 2014, followed by a rapid increase in incidence to 658.5 per 100,000 population in 2015, with a further increase to 746.6 per 100,000 population in 2016. The percentage of uninsured patients decreased from 19% to 14.3% and those with Medicaid coverage increased from 29.4% to 36.0%. The increase in ED utilization was greatest for individuals belonging to the lowest income quartile (895.1 per 100,000 population in 2013 to 964.0 per 100,000 in 2017). Overall, only 38.3% of the ED visits during the study period were due to emergent eye conditions. The inflation adjusted median charge per ED visit increased from $718.4 to $999.5 after the ACA was mandated.
Conclusions :
Although the ACA increased insurance coverage for Americans belonging to low socioeconomic status and minorities, it did not translate into improved and more equitable access to outpatient ophthalmic care. Emergency department utilization for non-emergent ophthalmic conditions continues to increase, resulting in more costly and less specialized care. Additional measures beyond expanding insurance coverage may be necessary to provide high quality, efficient and equitable healthcare to all Americans.
This is a 2021 ARVO Annual Meeting abstract.