De-insurance in Ontario has reduced use of eye care services by the socially disadvantaged

Abstract

ObjectiveEffective November 1, 2004, the Ontario Ministry of Health and Long-Term Care de-insured, or delisted, routine eye examinations for Ontarians aged 20 to 64 years. We examined whether this delisting reduced Ontarians' access to eye care providers (ophthalmologists and optometrists). DesignCross-sectional survey. ParticipantsOntario respondents to the Canadian Community Health Survey in 2000/2001 (n = 39 234 before delisting) and 2007/2008 (n = 43 835 after delisting). MethodsWe compared utilization rates of eye care providers by Ontarians in a 12-month period in 2000/2001 to utilization rates in 2007/2008 using self-reported data. ResultsAmong Ontarians aged 40 to 64 years, utilization was significantly reduced (−7.2%, p < 0.05) after delisting by those who did not have a secondary school graduation certificate. This was compared to a slight reduction (−0.7%, p > 0.05) by those who had completed secondary school or higher education. A reduction of −5.4% was observed among Ontarians in the lowest income quintile in contrast to increased utilization in all other income groups (p > 0.05). Before delisting, the gap in utilization between people with and without a secondary school graduation certificate was 4.7%. This gap doubled to 11.2% after delisting (p < 0.05). The disparity in utilization between those in the highest and lowest income quintile was 4.5% before delisting and 12.0% after delisting (p > 0.05). Cost was the likely barrier that resulted in this finding. ConclusionsThe use of eye care providers among socially disadvantaged Ontarians decreased significantly after vision care services were delisted. The effects of delisting appear to have caused an inequity in access to eye care providers, and that contradicts the objectives of the Canada Health Act.