Poor children in rural areas more likely to receive vision care than urban counterparts

Medicaid-enrolled children living in rural areas were more likely to receive vision care services than their counterparts living in urban areas, according to a study of all Michigan residents on Medicaid. The proportion of vision care provided by ophthalmologists alone, as opposed to optometrists, was found in the study to decrease with increasing age.

Alex Kemper, MD, MPH, and colleagues at the University of Michigan evaluated claims data over a 1-year period among children who were 18 years old or younger living in Michigan and continuously enrolled in Medicaid. Exclusion criteria included having a complex medical condition or being disabled. A total of 441,584 children were included in the analysis.

The main outcome measure was receiving vision care over a 1-year period. Vision care was divided into lens services (either corrective lenses or frames) or eye care services (exam by an ophthalmologist or optometrist, refraction, any office/outpatient visit or consultation with an optometrist/ophthalmologist, strabismus surgery or vision training). There were 363,187 vision care service claims for children in the study population.

In the study population, 52.4% of the children were nonwhite or Hispanic, 46.6% were non-Hispanic white, and the rest were not identified by race. The proportion of Hispanic or nonwhite children living in urban areas (60.6%) was significantly greater than the proportion of Hispanic or nonwhite children living in rural areas (8.9%). A total of 1,254 optometrists and 576 ophthalmologists served the residents of Michigan in 2001. Ophthalmologists were more concentrated in urban areas than optometrists.

The study found that 8.9% of the children included in the study received some kind of vision service during the year. Most eye care was provided by optometrists alone (76%). The rate of receipt of vision services increased with age, until decreasing slightly for children older than 15 years. Lens service rates also decreased slightly after children reached age 14 years.

“Ophthalmologists alone provided 55.3% of the care for children younger than 5 years but only 14.9% of the care for children 5 years and older (P < .001),” the authors reported.

More girls than boys received eye care and lens services. Also receiving more eye care and lens services were non-Hispanic white children, children living in rural counties and children who had fee-for-service Medicaid for the longest time.

“Contrary to our initial hypotheses, we found that the odds of receiving vision care were greater in rural counties than in urban ones,” the authors reported in the March issue of Pediatrics.