Authors: Prem Nichani, Graham E. Trope, Yvonne M. Buys, Samuel N. Markowitz, Sophia Liu, Gordon Ngo, Michelle Markowitz, Ya-Ping Jin.
Author Disclosure Block: P. Nichani: None. G.E. Trope: None. Y.M. Buys: Membership on advisory boards or speakers’ bureaus; Bausch and Lomb. All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Argentum Pharmaceuticals, Consultant. S.N. Markowitz: None. S. Liu: None. G. Ngo: None. M. Markowitz: None. Y. Jin: Funded grants or clinical trials; Kensington Eye Institute Research Fund, Glaucoma Research Society of Canada.

Abstract Body:

Purpose: To (1) determine the frequency and source of eyeglass insurance coverage in Ontario and changes from 2003 to 2013/14; (2) examine socio-demographic factors associated with eyeglass insurance; and (3) investigate if having eyeglass insurance is associated with increased utilization of eye care providers in a public-funded healthcare system.
Study Design: Cross-sectional survey.
Methods: Data from Ontariorespondents aged 12+ to the Canadian Community Health Survey in 2003 (n=42,777), 2005 (n=41,766) and 2013/14 (n=42,553) was analyzed.
Results: Overall, insurance covered all or part of the cost of prescription eyewear for 62.3% of Ontarians in 2003, 62.1% in 2005, and 62.0% in 2013/14. In 2005, 86% of those covered had employer-sponsored insurance, 9% had government-sponsorship, and 6% had a private plan. Corresponding numbers were 84%, 10% and 7% in 2013/14. From 2005 to 2013/14, government coverage increased from 29% to 42% (p<0.0001) for Ontarians without secondary school graduation and from 30% to 38% (p<0.0001) for those with household income under middle-level. Employer-sponsored coverage remained unchanged (92%) for individuals with household income above middle-level but decreased from 67% to 55% (p<0.0001) for Ontarians without secondary school graduation and from 64% to 53% (p<0.0001) for those with under middle-level income. An estimated 4.2 million Ontarians did not have any source of insurance in 2013/14. In all survey years, factors associated with having insurance were age younger than 65, post-secondary graduation, household income above middle-level, aboriginal status, and those in married/common-law relationships. In age groups with routine eye exams insured by government, having eyeglass insurance was associated with a significantly higher chance of visiting eye care providers in both bivariate and multiple regression analyses, with a difference in visiting eye care providers of 6% for the 12-19 age group and 7% for the 65+ age group. In age groups without government-insured routine eye exams, the difference in visiting eye care providers between those with and without eyeglass insurance was larger: 15% for the 20-39 age group and 11% for the 40-64 age group.
Conclusions: Eyeglass insurance coverage was 62% in Ontario and varied little from 2003 to 2013/14. The largest source of insurance was employer-sponsored, primarily covering high income earners; government-sponsored insurance significantly increased in lower income and education groups in recent years. Over 4 million Ontarians had no insurance in 2013/14 and were vulnerable to cost barriers for eyeglasses. Having eyeglass insurance was associated with significantly increased utilization of eye care providers.