Lack of Government-insured Annual Routine Eye Examinations Is
Associated with Increased Levels of Non Refractive Vision Problems amongst Low-income Elderly
Jin YP, Buys YM, Xiong J, Trope GE
October 23, 2012
Fredericton, New Brunswick
Background• In Canada: Each provincial/territorial government funds,
designs and manages their own health care services
• 13 provincial/territorial health insurance plans
• Eye care services: depend on where you live, how old you are and how much you are able or willing to pay
Newfoundland, New Brunswick, PEI
65+ residents: medically required ocular disease treatment covered by government but only after the clinical manifestations of the eye disease have become apparent
Ontario, Alberta, BC65+ residents:ocular disease assessment, treatment and annual eye exam
Hypothesis
Individual payment for routine eye exams
Utilization of eye care services
Avoidable vision loss
Aim
• To assess whether lack of government-insured annual routine eye examinations is associated with reduced vision health status amongst elderly Canadians
Methods - 1
• Self-reported data from 24,086 respondents who were 65 years or older and participated in the Canadian Community Health Survey (CCHS) 2000/2001
• CCHS is a nationwide health survey done by Statistics Canada
Methods - 2(i) “Are you usually able to see well enough to read ordinary
newsprint without glasses or contact lenses?”
(ii) “Are you usually able to see well enough to read ordinary newsprint with glasses or contact lenses?”
(iii) “Are you able to see at all?”
(iv) “Are you able to see well enough to recognize a friend on the other side of the street without glasses or contact lenses?”
(v) “Are you usually able to see well enough to recognize a friend on the other side of the street with glasses or contact lenses?”
Methods - 3
(a) No vision problems
(b) Problems corrected by lenses (distance, close, or both)
(c) Problems seeing distance (not corrected)
(d) Problems seeing close (not corrected)
(e) Problems seeing close and distance (not corrected) or no sight at all (blindness)
• Non refractive vision problems: (c) + (d) + (e)
Methods - 4
• Do you have glaucoma?
• How old were you when this was first diagnosed?
• Do you have cataracts?
• How old were you when this was first diagnosed?
Methods - 5• Eye care coverage provided by government health insurance plan: a report by Dr. Ralf Buhrmann et al for the National Coalition for Vision Health
Methods - 5Frequency of routine eye exams covered by government for people aged 65+
Provinces
Annually Ontario, Alberta, British Columbia, Quebec
One exam every 2-year calendar block Manitoba, Nova Scotia
Never insured or de-insured Saskatchewan, New Brunswick, PEI and Newfoundland
Annual routine eye exam covered by government
Provinces
Yes Ontario, Alberta, BC, Quebec
No Manitoba, Nova Scotia, Saskatchewan, New Brunswick, PEI and Newfoundland
Methods - 6• Survey weight
• Prevalence
• Odds ratio derived from logistic regression
model
Results
Results
• N=24, 086
• Mean age 74 years old
• Women 56%
0
10
20
30
40
50
60
70
80
56.3
47.9
73.1
50.0
39.5
69.9Annual eye exam insured
Annual eye exam not insuredU
tiliz
atio
n of
eye
car
e pr
ovid
ers
in th
e pa
st 1
2 m
onth
s (%
)
*
*: P<0.05
*
Non-Caucasians Caucasians 0
2
4
6
8 7.55
4.63
Pre
vale
nce
of n
on re
fract
ive
visi
on p
robl
ems
(%)
n=763 n=22,784
Under mid level Mid or high level0
2
4
6
87.45
4.26
Household income
Pre
vale
nce
of n
on re
fract
ive
visi
on p
robl
ems
(%)
P<0.05
Under mid income:
<$15,000 if 1 or 2
<$20,000 if 3 or 4
<$30,000 if 5+
Under mid Middle/high0
3
6
9
6.37
8.55Annual eye exam insured
Annual eye exam not insured
Household income
Pre
vale
nce
of n
on re
fract
ive
visi
on p
robl
ems
(%)
Under midCaucasians only
Under mid Middle/high0
3
6
9
6.37
4.28
8.55
3.60
Annual eye exam insured
Annual eye exam not insured
Household income
Pre
vale
nce
of n
on re
fract
ive
visi
on p
robl
ems
(%)
Caucasians only
Insured with mid/high income
Insured with in-come under mid
Not-insured with mid/high income
Not-insured with income under
mid
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1
1.23
0.730000000000001
1.51A
djus
ted
odds
rat
io o
f non
ref
ract
ive
visi
on p
robl
ems Caucasians only
Glaucoma Cataracts0
5
10
15
20
25
5.7
20.9
6.7
21.4Annual eye exam insured
Annual eye exam not insured
Pre
vale
nce
(%)
Caucasians only
Glaucoma Cataracts62
64
66
68
70
72
74
66.6
70.8
68.1
72.5Annual eye exam insured
Annual eye exam not insured
Age
at d
iagn
osis
(Yea
rs)
P<0.05
n 967 469 1445 3550
Caucasians only
Conclusions
• Lack of government insurance for annual routine eye examinations is associated with an increased level of non refractive vision problems amongst the low-income elderly
• This negative association is buffered by high household income
Limitation & Strength
• Unable to distinguish whether self-reported non refractive vision problems are medically correctable or not
• Large, nationwide, representative sample
Funding:
Thank you!
Insured with mid/high income
Insured with in-come under mid
Not-insured with mid/high income
Not-insured with income under
mid
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1
1.22
0.730000000000001
1.51A
djus
ted
odds
rat
io o
f non
ref
ract
ive
visi
on p
robl
ems
1.41
1.44
0.78
1.29
Caucasians only
0.79
1.23
Sensitivity analysis: Red: MB & NS were removedGreen: MB and NS included in insured group
Canada Health Act - Frequently Asked Questions (http://www.hc-sc.gc.ca/hcs-sss/medi-assur/faq-eng.php#a3 )
• The Canada Health Act ensures that all residents of Canada have reasonable access to medically necessary hospital and physician services on a prepaid basis, and on uniform terms and conditions.
• A number of services provided by hospitals and physicians are not considered medically necessary, and are not insured by provincial and territorial health insurance plans.
• Provinces and territories may also offer "additional benefits" under their respective health insurance plans, funded and delivered on their own terms and conditions. These benefits vary across different provinces and territories, examples include prescription drugs, dental care, optometric, chiropractic, and ambulance services.
