Jin YP, Buys YM, Xiong J, Trope GE October 23, 2012 Fredericton, New Brunswick

1. 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

2. 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 Background

3. Individual payment for routine eye exams Hypothesis Utilization of eye care services Avoidable vision loss

4. Aim To assess whether lack of government-insured annual routine eye examinations is associated with reduced vision health status amongst elderly Canadians

5. 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

6. Methods - 2 “Are you usually able to see well enough to read ordinary newsprint without glasses or contact lenses?” “Are you usually able to see well enough to read ordinary newsprint with glasses or contact lenses?” “Are you able to see at all?” “Are you able to see well enough to recognize a friend on the other side of the street without glasses or contact lenses?” “Are you usually able to see well enough to recognize a friend on the other side of the street with glasses or contact lenses?”

7. No vision problems • Problems corrected by lenses (distance, close, or both) • Problems seeing distance (not corrected) • Problems seeing close (not corrected) • Problems seeing close and distance (not corrected) or no sight at all (blindness) • Non refractive vision problems: (c) + (d) + (e) Methods - 3

8. 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 - 4

9. 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

10. Methods - 5

11. Survey weight • Prevalence • Odds ratio derived from logistic regression model Methods - 6

12. Results

13. Results • N=24, 086 • Mean age 74 years old • Women 56%

14. * *: P<0.05

15. n=22,784 n=763

16. Under mid income: <$15,000 if 1 or 2 <$20,000 if 3 or 4 <$30,000 if 5+ P<0.05

17. Caucasians only

18. Caucasians only

19. Caucasians only

20. Caucasians only

21. Caucasians only 967 469 1445 3550

22. 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

23. Limitation & Strength • Unable to distinguish whether self-reported non refractive vision problems are medically correctable or not • Large, nationwide, representative sample

24. Thank you! Funding:

25. Caucasians only Sensitivity analysis: Red: MB & NS were removed Green: MB and NS included in insured group 1.23 0.79

26. 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.