Table 15.4 Changes in average daily screening volume associated with a change in fees charged to patients

resumed. Screening volume decreased by a consistent 40% at each site when patients were charged the fees. Demand is sensitive to price (Table 15.4).

15.9Conclusion

Overall, screening for diabetic retinopathy through telemedicine has been successful in reducing the cost of diabetic eye exams dramatically, but even these reduced costs present a barrier to access in the safety net. Patients and society realize benefits from screening, but those benefits are in the form of avoided costs and thus may be under recognized as budget and health-care decisions are being made. Additional benefit could be realized if additional resources are applied to screening and treatment.

Just enacted Medi-Cal reimbursements will help, but most patients in California’s safety net are uninsured and will still not be covered, although health-care reform may result in more people being covered in the future. Providers have been absorbing most of the costs of screening, although some providers pass some of the costs to patients in the form of co-payments. There is evidence that suggests that passing charges on to patients reduces the number of patients who access screens.

Realizing the full benefit of screening requires that patients found to have diabetic retinopathy receive effective and timely treatment, but the same barriers to access have been found to exist. Most patients in the EADRSI were not able to access follow-up care in a timely manner.

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