Delisted routine eye examinations for nonrefractive eye conditions: a comparative analysis

Abstract

Background: In 2004, Ontario delisted routine eye examinations for people aged 20-64 years, potentially encouraging patients seeking eye care to visit government-insured primary care providers (PCPs) rather than optometrists whose services had been deinsured. We investigated if utilization of PCP services for nonrefractive eye conditions increased after 2004 among Ontarians who were affected by the delisting.

Methods: We conducted a comparative analysis of the utilization of PCP services for nonrefractive eye conditions in Ontario using administrative data from 2000 to 2014. We included participants without a visit to government-insured optometrists or ophthalmologists in the year before the study year; we excluded participants with existing diabetes. Changes in utilization before and after delisting were statistically assessed using segmented regression analysis in subgroups stratified by age, sex, rurality and neighbourhood income.

Results: A significant increase in utilization of PCP services for nonrefractive ocular diagnoses after 2004 was documented among people affected by the delisting: 17.8% (95% confidence interval [CI] 17.0% to 18.7%) for people aged 20-39 years and 11.6% (95% CI 10.6% to 12.5%) for people aged 40-64 years. This corresponds to an increase in the number of patients who visited PCPs for nonrefractive ocular diagnoses of 10 690 (95% CI 321 to 21 059) for people aged 20-39 years and 20 682 (95% CI -94 to 41 457) for people aged 40-64 years. Among people aged 65 years and older (an age group not affected by the delisting), utilization of PCP services for nonrefractive ocular diagnoses was stable (p = 0.95) throughout the study period. Changes in utilization of PCP services for nonocular diagnoses were nonsignificant among people aged 0-19, 40-64 and 65 years and older.

Interpretation: After delisting, utilization of the services of government-funded PCPs for nonrefractive ocular diagnoses significantly increased among Ontarians affected by the delisting. The impact on ocular outcomes and the cost-effectiveness of increased use of PCPs for ocular management warrants further investigation and policy-makers' consideration.

Figure 1:

Utilization rate of services from government-insured primary care providers (family physicians and pediatricians) for nonrefractive ocular diagnoses from 2000 to 2014 by patient age group in Ontario. Utilization rate (%) is defined as the number of people with a nonrefractive ocular diagnosis who had a claim submitted by primary care providers among the total number of people with a nonrefractive ocular diagnosis who had a claim submitted to the Ontario Health Insurance Plan by all health care providers.

Figure 2:

Utilization rate of services from government-insured primary care providers (family physicians and pediatricians) for dermatologic diagnoses from 2000 to 2014 by patient age group in Ontario. Utilization rate (%) is defined as the number of people with a dermatologic diagnosis who had a claim submitted by primary care providers among the total number of people with a dermatologic diagnosis who had a claim submitted to the Ontario Health Insurance Plan by all health care providers.

Figure 3:

Utilization rate of services from government-insured optometrists from 2000 to 2014 by patient age group in Ontario. Utilization rate (%) is defined as the number of people with a nonrefractive ocular diagnosis who had a claim submitted by optometrists among the total number of people with a nonrefractive ocular diagnosis who had a claim submitted to the Ontario Health Insurance Plan by all health care providers.

Figure 4:

Utilization rate of services from government-insured ophthalmologists from 2000 to 2014 by patient age group in Ontario. Utilization rate (%) is defined as the number of people with a nonrefractive ocular diagnosis who had a claim submitted by ophthalmologists among the total number of people with a nonrefractive ocular diagnosis who had a claim submitted to the Ontario Health Insurance Plan by all health care providers.