Impact of eyewear insurance coverage on utilization of eyecare providers in Ontario, Canada.

Abstract

Objective: To obtain prescription eyewear in Ontario, eye exams must be performed by optometrists or ophthalmologists (eye care providers [ECPs]). In 2004, government-insured routine eye exams were delisted for Ontarians aged 20-64 leaving eye exam coverage only for those aged ≤19 and 65+. We assessed whether having eyewear insurance impacts Ontarians' utilization of ECPs.

Design: Cross-sectional survey.

Participants: Ontarians aged 12+ without diabetes responding to the Canadian Community Health Survey in 2003, 2005, and 2013/2014.

Methods: We compared the utilization of ECPs by eyewear insurance status and eligibility for government-funded eye exams. Individuals with eyewear insurance funded by employers, government or privately were considered to have insurance.

Results: ECP utilization was significantly higher in Ontarians with eyewear insurance versus those without, in all survey years and all age groups, including those eligible for government-funded eye exams (e.g., 66.4% vs 59.1% [p < 0.05] for the 65+). This higher level of utilization was particularly evident among Ontarians aged 20-64 in 2013/2014, when this group no longer had government-funded eye exams (34.9% vs 19.9% among 20-39-year-olds, 43.4% vs 32.9% among 40-64-year-olds, p < 0.05 for both). Adjusting for confounding effects, the likelihood of visiting an ECP was greater among Ontarians with eyewear insurance than those without (adjusted prevalence ratio 1.26 for Ontarians aged 12+ and 1.41 for those aged 20-64; p < 0.05 for both).

Conclusions: Lack of eyewear insurance negatively impacts the utilization of ECPs, even among Ontarians eligible for government-funded eye exams, where the cost barrier for eye exams has been removed by the Ontario government.