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Reimbursements and Resources for Pediatric Vision Screening

Correspondence: Requests for reprints should be addressed to: James B. Ruben, M.D., Northern California Permanente Medical Group, 1650 Response Rd., Sacramento, CA 95815.

Background and Purpose: Despite accelerating growth in United States health care spending, expenditures for pediatric vision screening and treatment of amblyopia remain static. Recent studies have provided new insight into the value of amblyopia screening and treatment. Reasons for the relative lack of resources directed toward pediatric vision screening and proposals for positive future changes are discussed.

Patients and Methods: A review of pertinent literature on the topic of the economics of pediatric vision screening and amblyopia treatment is presented. Methods to evaluate the relative value of medical interventions are examined as they pertain to pediatric vision screening. Comparisons of the value of pediatric vision screening to other medical interventions and to comprehensive preschool eye examinations are presented.

Results: There is no published data on the amount of money spent in the United States on pediatric vision screening. However, current studies estimate the cost for a vision screening examination to be approximately $10 to $20. The Cost/Quality Adjusted Life-Year (QALY) for Pediatric vision screening over "usual care" is approximately $6000/QALY. Amblyopia treatment is estimated to cost approximately $2000/QALY.

Conclusions: Pediatric vision screening is highly cost-effective relative to other medical expenditures and relative to mandatory comprehensive eye examinations. Current economic incentives for performing pediatric vision screening are inadequate and are disproportionately low relative to the benefits received. Inadequate reimbursements discourage commercial interest in pediatric vision screening, bridling technical advancement and political interest for improving the status quo in vision screening. Placement on universal quality measures such as the HMO "report cards" or new "pay-for-performance" measures would stimulate economic interest in pediatric vision screening.

Key words: pediatric vision screening, amblyopia, economics, cost-utility analysis, quality measures