Abstract
Purpose :
In 2004, Ontario de-insured routine eye exams for individuals aged 20-64 unless they had a diagnosed eye disease, diabetes or obtained a valid physician referral. We investigated if de-insurance affected Ontarian’s use of government-insured services provided by optometrists and primary care providers (PCPs, including family physicians, paediatricians and nurse practitioners).
Methods :
OHIP (Ontario Health Insurance Plan) billing data from 2000 to 2014 were analyzed. Included were individuals without diabetes and/or a visit to an OHIP-insured ophthalmologist/optometrist one year prior to the study year. The use of OHIP-insured services provided by optometrists and PCPs for eye diagnoses was compared post- vs. pre-2004 using the interrupted time-series analysis. Eye disease diagnoses were identified using ICD-9 codes. Diabetes was excluded and included as a part of eye diagnoses. Practitioner’s specialty was recognized using specialty codes.
Results :
A significant decrease was seen in use of OHIP-insured optometric services post- vs. pre-2004 among de-insured age group when diabetes was excluded as a part of eye diagnoses: -57% (p<0.0001) for the 20-39 group and -42% (p<0.0001) for the 40-64 group. Among de-insurance unaffected 0-19 and 65+ groups, a non-significant change was observed (p>0.05) in use of OHIP-insured optometric services.
The use of OHIP-insured PCP services for eye diagnoses post- vs. pre-2004 among de-insured age groups increased significantly: +30% (p<0.0001) for the 20-39 group, and +16% (p<0.0001) for the 40-64 group. This increase was observed in males, females and all income earners. Among de-insurance unaffected age groups changes in use of PCPs for eye diagnoses were non-significant (p>0.05 for both 0-19 and 65+ group).
The use of PCPs for non-ocular diagnoses remained stable post- vs. pre-2004 in both de-insurance affected and unaffected individuals.
Trends were similar when diabetes was included as a part of eye diagnoses.
Conclusions :
Post-delisting, OHIP claims by optometrists decreased significantly while PCP claims for ocular diagnoses increased among de-insured Ontarians. Due to different levels of equipment and skills among PCPs compared with optometrists, the efficiency and cost-effectiveness of increased use of PCPs for eye diagnosis and management warrants further investigation.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.