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Yaping Jin, Yvonne Buys, Wendy Hatch, Graham E. Trope; Cutting Publically Funded Eye Care Services in Ontario Reduced Access to Eye Care. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5525.
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Effective November 1, 2004, the Ontario Ministry of Health and Long-Term Care delisted/removed routine eye exams for Ontarians aged 20-64. Since then, Ontario residents in this age group have been paying for these vision services, or have had the cost of the exams covered by private insurance. We examined whether delisted eye exams reduced the public’s access to eye care providers.
We compared the utilization rate of eye care providers (ophthalmologists or optometrists) amongst Ontarians aged 12 years or over in 2000/2001 (n=39,234 before delisting) to the utilization rate in 2007/2008 (n=43,835 after delisting) using data from the Canadian Community Health Survey. Utilization of eye care providers (or realized access) was defined as self-reports of having seen or talked on the telephone with an eye care provider over a 12-month period. All analyses were done with the bootstrap weights provided by the Statistics Canada.
The overall utilization after delisting decreased slightly (29.2% vs 27.5%) for people aged 20-39 years, remained stable (41.2% vs 40.3%) for those aged 40-64 years, but increased for persons aged 12-19 years (39.7% vs 43.7%) or 65 years or older (59.2% vs 63.9%) who were not affected by delisting.Amongst Ontarians aged 40-64, significantly reduced utilization (-7.2%, p<0.05) after delisting was observed for those who did not have a secondary school graduation certificate. The reduction after delisting was -0.7% (p>0.05) for those who completed secondary school or higher. A reduction of -5.4% was also observed amongst Ontarians in the lowest income quintile. This is in contrast to an increased utilization in all other income groups.Before delisting, the gap in utilization between people without a secondary school graduation certificate and those with secondary school or higher was -4.7% (37.4% vs 42.1%, p=0.0010). This gap doubled significantly to -11.2% (30.2% vs 41.4%, p<0.0001) after delisting (p<0.05). The disparity in eye care utilization between highest and lowest income quintile was -4.5% before delisting (39.3% vs 43.8%, p=0.0003) and -12.0% after delisting (33.9% vs 45.9%, p<0.0001).
Delisting appears to have promoted reduced access to eye care providers amongst the socially disadvantaged. The effects of delisting seem to contradict the objectives of the Canada Health Act.
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