Jeon William, Trope Graham E, Glazier Richard H, Brent Michael H, Buys Yvonne M, Jin Ya-Ping
Institute of Medical Science (Jeon, Trope, Glazier, Brent, Jin) and Department of Ophthalmology and Vision Sciences (Trope, Brent, Buys, Jin), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto and St. Michael's Hospital; ICES (Glazier), Toronto, Ont.
CMAJ Open. 2020 Jul 15;8(3):E479-E486. doi: 10.9778/cmajo.20190125. Print 2020 Jul-Sep.
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.
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.
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 ( = 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.
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.
2004年，安大略省不再将20至64岁人群的常规眼部检查纳入医保范围，这可能促使寻求眼部护理的患者去看政府承保的初级保健医生（PCP），而非去看那些服务已不再享受医保的验光师。我们调查了2004年后，受医保范围调整影响的安大略省居民中，因非屈光性眼部疾病而使用初级保健医生服务的情况是否有所增加。
我们利用2000年至2014年的行政数据，对安大略省因非屈光性眼部疾病而使用初级保健医生服务的情况进行了比较分析。我们纳入了在研究年份前一年未去看过政府承保的验光师或眼科医生的参与者；排除患有糖尿病的参与者。使用分段回归分析，在按年龄、性别、城乡差异和社区收入分层的亚组中，对医保范围调整前后的使用情况变化进行统计学评估。
在受医保范围调整影响的人群中，2004年后因非屈光性眼部诊断而使用初级保健医生服务的情况显著增加：20至39岁人群为17.8%（95%置信区间[CI] 17.0%至18.7%），40至64岁人群为11.6%（95%CI 10.6%至12.5%）。这相当于20至39岁人群中，因非屈光性眼部诊断而去看初级保健医生的患者人数增加了10690人（95%CI为321至21059人），40至64岁人群增加了20682人（95%CI为 -94至41457人）。在65岁及以上人群（该年龄组未受医保范围调整影响）中，因非屈光性眼部诊断而使用初级保健医生服务的情况在整个研究期间保持稳定（ = 0.95）。在0至19岁、40至64岁以及65岁及以上人群中，因非眼部诊断而使用初级保健医生服务的情况变化不显著。
医保范围调整后，受影响的安大略省居民中，因非屈光性眼部诊断而使用政府资助的初级保健医生服务的情况显著增加。这种变化对眼部治疗效果的影响以及增加使用初级保健医生进行眼部治疗的成本效益，值得进一步研究并引起政策制定者的关注。
