Abstract
Purpose :
Social determinants of health, especially insurance status, socioeconomic status, and race, have been linked to poor outcomes in patients with glaucoma. The Affordable Care Act (ACA) was passed to address such disparities in access to care, but there is a paucity of literature assessing its efficacy in facilitating access to ophthalmologic care. We evaluated demographic and cost differences between ACA patients who were eligible for trabecular bypass device (TBD) surgery and did or did not receive it.
Methods :
This is a retrospective, claims-based cohort study using a novel 2017 to 2019 claims dataset of Affordable Care Act (ACA) marketplace plan subscribers containing deidentified data about medical conditions, procedures, and associated cost (yearly mean n= 3,560,440). Socioeconomic status was inferred from eligibility for cost-sharing reduction subsidies based on the federal poverty limit. ICD-10 and CPT codes identified patients who underwent cataract surgery and were eligible for TBD surgery (n=653) as well as those who went on to receive TBD surgery (n=249).
Results :
A statistically significant difference was found in TBD surgery rates between lower income ACA marketplace subscribers with subsidies and higher income patients who were subsidy ineligible (27.6% vs 43.0%, p=0.0035, multiple logistic regression). Lower income patients paid less out-of-pocket TBD cost due to subsidies ($324 vs $2494, p<0.001, Mann-Whitney U test) compared to higher income patients. Actual out-of-pocket costs for TBD surgery were similar to expected costs as advertised on the ACA website.
Conclusions :
This investigation of novel ACA claims data highlights a potential disparity in access to TBD surgery for lower income ACA patients. Despite paying much less out-of-pocket, lower income patients receive TBD surgery at lower rates than their higher income peers. Our study design precludes analysis of the individual decisions that contribute to this difference in rates and the role of race. Our investigation examines health equity using a novel ACA dataset and, to our knowledge, is the first to assess eye surgical referral rates and cost experience among the ACA population.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.