Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont.
CMAJ Open. 2021 Mar 17;9(1):E224-E232. doi: 10.9778/cmajo.20200104. Print 2021 Jan-Mar.
Insurance coverage may reduce cost barriers to obtain vision correction. Our aim was to determine the frequency and source of prescription eyewear insurance to understand how Canadians finance optical correction.
We conducted a repeated population-based cross-sectional study using 2003, 2005 and 2013-2014 Canadian Community Health Survey data from respondents aged 12 years or older from Ontario, Canada. In this group, the cost of prescription eyewear is not covered by the government unless one is registered with a social assistance program or belongs to a specific population. We determined the frequency and source of insurance coverage for prescription eyewear in proportions. We used survey weights provided by Statistics Canada in all analyses to account for sample selection, a complex survey, and adjustments for seasonal effect, poststratification, nonresponse and calibration. We compared unadjusted proportions and adjusted prevalence ratios (PRs) of having insurance.
Insurance covered all or part of the costs of prescription eyewear for 62% of Ontarians in all 3 survey years. Of those insured, 84.1%-86.0% had employer-sponsored coverage, 9.0%-10.3% had government-sponsored coverage, and 5.7%-6.8% had private plans. Employer-sponsored coverage remained constant for those in households with postsecondary graduation but decreased significantly for those in households with less than secondary school graduation, from 67.0% (95% confidence interval [CI] 63.2%-70.8%) ( = 175 000) in 2005 to 54.6% (95% CI 50.1%-59.2%) ( = 123 500) in 2013-2014. Government-sponsored coverage increased significantly for those in households with less than secondary school graduation, from 29.2% (95% CI 25.5%-32.9%) ( = 76 400) in 2005 to 41.7% (95% CI 37.2%-46.1%) ( = 93 900) in 2013-2014. In 2013-2014, Ontarians in households with less than secondary school graduation were less likely than those with secondary school graduation to report employer-sponsored coverage (adjusted PR 0.79, 95% CI 0.75-0.84) but were more likely to have government-sponsored coverage (adjusted PR 1.27, 95% CI 1.06-1.53).
Sixty-two percent of Ontarians had prescription eyewear insurance in 2003, 2005 and 2013-2014; the largest source of insurance was employers, primarily covering those with higher education levels, whereas government-sponsored insurance increased significantly among those with lower education levels. Further research is needed to elucidate barriers to obtaining prescription eyewear and the degree to which affordability impairs access to vision correction.
保险覆盖范围可能会降低获得视力矫正的费用障碍。我们的目的是确定处方眼镜保险的频率和来源，以了解加拿大人如何为光学矫正提供资金。
我们使用加拿大安大略省 2003 年、2005 年和 2013-2014 年加拿大社区健康调查数据进行了一项基于人群的重复横断面研究，调查对象为年龄在 12 岁及以上的人群。在该组中，除非一个人注册了社会援助计划或属于特定人群，否则政府不承担处方眼镜的费用。我们以比例的形式确定了处方眼镜保险的频率和来源。我们在所有分析中都使用了加拿大统计局提供的调查权重，以考虑样本选择、复杂的调查以及季节性影响、事后分层、无应答和校准的调整。我们比较了未调整的比例和有保险的调整患病率比（PR）。
在所有 3 项调查年份中，有 62%的安大略省人拥有涵盖全部或部分处方眼镜费用的保险。在有保险的人群中，84.1%-86.0%的人有雇主赞助的保险，9.0%-10.3%的人有政府赞助的保险，5.7%-6.8%的人有私人计划。对于那些有中学以上学历的家庭来说，雇主赞助的保险仍然保持不变，但对于那些中学以下学历的家庭来说，雇主赞助的保险显著下降，从 2005 年的 67.0%（95%置信区间[CI] 63.2%-70.8%）（= 175,000）降至 2013-2014 年的 54.6%（95% CI 50.1%-59.2%）（= 123,500）。对于那些中学以下学历的家庭来说，政府赞助的保险显著增加，从 2005 年的 29.2%（95% CI 25.5%-32.9%）（= 76,400）增至 2013-2014 年的 41.7%（95% CI 37.2%-46.1%）（= 93,900）。在 2013-2014 年，与中学毕业的家庭相比，中学以下学历的安大略人更不可能报告有雇主赞助的保险（调整后的 PR 0.79，95% CI 0.75-0.84），但更有可能获得政府赞助的保险（调整后的 PR 1.27，95% CI 1.06-1.53）。
2003 年、2005 年和 2013-2014 年，62%的安大略人有处方眼镜保险；最大的保险来源是雇主，主要覆盖那些受过高等教育的人，而政府赞助的保险在教育程度较低的人群中显著增加。需要进一步研究以阐明获得处方眼镜的障碍以及负担能力对视力矫正获得程度的影响。
