News reports from the conference

Delisting of eye services affecting disadvantaged

The delisting of routine eye examinations in Ontario appears to have had a negative effect on those with the lowest education and income.

Dr. Yaping Jin, an ophthalmic epidemiologist from the University of Toronto faculty of medicine presented the results of a cross-sectional survey on visits to ophthalmologists and optometrists in the years before and after the provincial government decision.

Study rationale

The study was designed to evaluate the impact on the utilization rate of eye care providers by the decision to remove coverage of routine eye exams for Ontario residents aged 20-64 years from the Ontario Health Insurance Plan that came into effect Nov 1, 2004. The move meant that this population now had to either pay directly for exams or have the costs covered by private insurance.

Study design

Data from the Canadian Community Health Survey conducted by Statistics Canada was used to compare visits to eye care providers in 2000-2001 (n = 39,278) and 2007-2008 (n = 43,958).

Respondents were asked how many times in the past year they had seen or spoken on the telephone with an eye specialist such as an ophthalmologist or optometrist.

Findings

The survey found that use of eye care providers increased for younger and older people not affected by the delisting. For those aged 12-19 years, visit rates increased from 39.7% to 43.7% and for those 65 years or older, it increased from 59.2% to 63.9%. For the two age groups affected by the delisting of eye visits, use decreased slightly from 29.2% to 27.5% for those aged 20-39 years and from 41.2% to 40.3% for those aged 40-64 years.

However, when the study population was assessed by education and income levels, significant differences were seen between the two study periods.

For those who did not graduate from secondary school, visits to eye care providers dropped significantly by 7.2% in the period after delisting while it remained stable for those with more education. For those in the lowest income quintile there was a 5.4% drop in eye care visits after the government decision.

This saw a widening of disparities with the gap in use between those with less and more education more than doubling, from -4.7% before delisting to -11.2% after (p < 0.05). A similar difference was also seen between the highest and lowest income quintiles where the gap was -4.5% before delisting and -12% after.

Conclusions

Jin and her colleagues Yvonne Buys, Wendy Hatch and Graham Trope concluded that the delisting of routine eye examinations in Ontario appears to have had a negative differential impact on the socially disadvantaged - a move at odds with the objectives of the Canada Health Act.