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Chris Hong, Graham Trope, Yvonne Buys, Barbara Robinson, Yaping Jin; Does government assistance improve access for low-income individuals to eye care providers?. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4542.
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To evaluate if low-income support programs facilitate access to eye care providers in Canada.
We systematically reviewed government-funded low-income vision care support programs and compared them with the average fee charged for routine eye exams in 10 Canadian provinces. We then compared utilization of eye care providers between those likely eligible for vision care assistance versus those likely not eligible using data from the Canadian Community Health Survey (CCHS) Healthy Aging 2008/09.
The CCHS data reveals that 12.5% of Canadians aged 45-64 and 13.2% of those aged 65+ have difficulty meeting basic expenses such as food, shelter and clothing. Individuals are eligible for vision care assistance only if they are receiving government financial assistance. The Canadian Financial Capability Survey revealed that 7.9% of Canadians aged 45-64 and 5.5% aged 65+ received social assistance and provincial supplements in 2009. The cost of routine eye exams in Canada is not covered by government for those aged 20-64. In 4 provinces (NFLD, PEI, NB, SK) seniors are also not covered. For those receiving financial assistance the government covers maximum 70% of the eye exam cost in one province (NB). In two provinces the government coverage is less than the average fee charged by optometrists ($55 by government vs $65 by optometrists in NFLD; $52 by government vs $84-$90 by optometrists in PEI). Waiving the fee difference however is at optometrist’s discretion. Among middle-aged Caucasians who did not report having glaucoma, cataracts, diabetes and vision problems, utilization of eye care providers was lower among those reporting difficulty meeting basic expenses when compared to those without difficulty (28.2% versus 42.0%, p<0.05). Utilization was 25.0% for those in the lowest 10% income decile (p<0.05) and 22.5% for those in the 11%-20% income decile (p<0.05) compared to 42.1% in the 21%-100% income distribution. When effects of age, sex and education were adjusted for, Caucasians having difficulty meeting basic needs used an eye care provider significantly less often than those without difficulty: about 30% less often for those aged 45-64 (prevalence ratio (PR) 0.68, 95% CI 0.57-0.80) and about 10% less often for seniors (PR 0.88, 95% CI 0.78-0.99).
Despite government assistance, the poor have significantly reduced utilization of vision care.
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