Alleviating Costs for Critical Eye Specialty Services (ACCESS): a prospective cohort analysis of a cost-coverage program at a public safety-net hospital

In the United States, gaps in public insurance coverage and high out-of-pocket costs for specialty ophthalmic services contribute substantially to preventable vision loss and disability among underserved populations. We describe the structure, implementation, and early outcomes of ACCESS (Alleviating Costs for Critical Eye Specialty Services), a hospital-based cost-coverage program established at an urban safety-net hospital to address these financial barriers. ACCESS delivers essential vision-restorative treatments frequently excluded from insurance coverage at no cost through hospital support and philanthropic funding. Prospective clinical and demographic data demonstrated marked reductions in visual disability among treated patients and substantial downstream economic benefit relative to program costs. These findings demonstrate that targeted cost-coverage programs embedded within safety-net systems can reduce disparities in vision care, while providing actionable evidence to inform hospital policy development and support broader expansion of insurance coverage for high-impact ophthalmic specialty services.