Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.
Can J Ophthalmol. 2012 Jun;47(3):203-10. doi: 10.1016/j.jcjo.2012.03.017. Epub 2012 May 12.
Effective 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).
Cross-sectional survey.
Ontario respondents to the Canadian Community Health Survey in 2000/2001 (n = 39 234 before delisting) and 2007/2008 (n = 43 835 after delisting).
We 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.
Among 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.
The 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.
2004 年 11 月 1 日起，安大略省卫生和长期护理部取消了安大略省 20 至 64 岁人群的常规眼科检查保险，或删除了这些保险。我们研究了这种取消保险是否会减少安大略省居民获得眼科护理提供者（眼科医生和验光师）的机会。
横断面调查。
2000/2001 年加拿大社区健康调查的安大略省应答者（取消保险前为 39234 人）和 2007/2008 年（取消保险后为 43835 人）。
我们使用自我报告的数据，比较了安大略省在 2000/2001 年的 12 个月内和 2007/2008 年的眼科护理提供者利用率。
在 40 至 64 岁的安大略省居民中，未完成中学教育的人在取消保险后利用率显著下降（-7.2%，p < 0.05），而完成中学或更高教育的人则略有下降（-0.7%，p > 0.05）。在收入最低的五分位数的安大略省人中观察到利用率下降了-5.4%，而所有其他收入组的利用率均有所增加（p > 0.05）。取消保险前，有中学毕业证书和没有中学毕业证书的人的利用率差距为 4.7%。取消保险后，这一差距扩大到 11.2%（p < 0.05）。收入最高和最低五分位数之间的利用率差距在取消保险前为 4.5%，取消保险后为 12.0%（p > 0.05）。费用很可能是导致这种结果的障碍。
在视力保健服务被取消后，安大略省社会劣势人群对眼科护理提供者的使用明显减少。取消保险的影响似乎导致了获得眼科护理提供者机会的不平等，这与《加拿大卫生法》的目标相矛盾。
