De-insured routine eye exams and associated increased use of family physicians and ophthalmologists for glaucoma diagnosis

Abstract

Purpose : Government-insured routine eye exams by optometrists and physicians for individuals aged 20-64 were delisted in Ontario, Canada in 2004. Since then, individuals affected by the policy may visit family physicians (FPs) for eye-related concerns to avoid out-of-pocket payment. We investigated if delisting was associated with increased use of FPs and ophthalmologists for glaucoma diagnosis.

Methods : Using population-based health service data from the Ontario Health Insurance Plan (OHIP) from 1997-2019, we compared the yearly proportion of people with a glaucoma diagnosis claimed by FPs or ophthalmologists among the total number of individuals with a glaucoma diagnosis claimed by all OHIP physicians. We conducted an interrupted time series analysis to assess if changes in the utilization of FPs or ophthalmologists before and after delisting were the result of chance alone or policy change. Ontarians aged 20-64 were in the policy-affected group. Those aged 65+ were in the policy-unaffected group.

Results : In the policy-affected age groups, the utilization rate of FPs for glaucoma diagnosis significantly increased immediately following delisting: 14.6% (95% confidence interval [CI] 11.0%~18.3%) for the 20-39 age group and 9.9% (95% CI 8.2%~11.5%) for the 40-64 age group. The utilization of ophthalmologists for glaucoma diagnoses increased substantially post-delisting: 41.5% (95% CI 37.8%~45.3%) for the 20-39 age group and 40.3% (95% CI 35.7%~45.0%) for the 40-64 age group. There was a significant increase in the number of glaucoma referrals from FPs to optometrists immediately after delisting (569, 95% CI 445~694) and from FPs to ophthalmologists after 2006 (1471, 95% CI 769~2174).

In the policy-unaffected 65+ group, the utilization rate of FPs (1.9% (95% CI 0.6%~3.2%)) and ophthalmologists (4.4% (95% CI 0.4%~8.4%)) for glaucoma diagnoses increased minimally post-delisting. The number of glaucoma referrals did not significantly change post-delisting from FPs to ophthalmologists (-11, 95% CI -315~293) and increased marginally from FPs to optometrists after 2010 (38, 95% CI 3~73).

Conclusions : Delisting routine eye exams for individuals aged 20-64 resulted in an increased use of FPs and ophthalmologists for glaucoma diagnosis. Further studies are needed to understand the effects of delisting and its related cost-effectiveness to the health system.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.