Frequency and source of prescription eyewear insurance coverage in Ontario: a repeated population-based cross-sectional study using survey data.

BACKGROUND: 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. METHODS: 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. RESULTS: 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%) (n = 175 000) in 2005 to 54.6% (95% CI 50.1%-59.2%) (n = 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%) (n = 76 400) in 2005 to 41.7% (95% CI 37.2%-46.1%) (n = 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). INTERPRETATION: 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.

Significant disparities in eyeglass insurance coverage in Canada.

OBJECTIVE: To describe patterns of access to eyeglass insurance by Canadians. DESIGN: A population-based, cross-sectional survey. PARTICIPANTS: A total of 134 072 respondents to the Canadian Community Health Survey 2003 who were aged ≥12 years. METHODS: We compared self-reported insurance coverage for eyeglasses or contact lenses provided by private, government, or employer-paid plans. RESULTS: Overall, 55.0% of Canadians aged ≥12 years had insurance that covers all or part of the costs of optical correction. School-age children (63.3%) and individuals aged 20-39 years (55.9%) and 40-64 years (59.5%) had higher coverage rates than seniors (aged ≥65 years) (33.8%, p < 0.05). Canadians residing in the 3 territories had the highest coverage (76.9%), while those in Quebec had the lowest coverage (39.1%, p < 0.05). Lower coverage was reported among immigrants (47.3%) versus nonimmigrants (57.4%, p < 0.05), nonwhites (49.2%) versus whites (56.4%, p < 0.05) and aboriginals (70.7%), and the self-employed (38.5%) versus employees (63.8%). Among Canadians in the 20-64 years age group, individuals in the lower or middle income bracket were 40% (prevalence ratio [PR] 0.60, p < 0.05) less likely to have insurance than those in the upper-middle or higher income bracket after adjusting for ethnicity, immigrant status, and education. Compared to those with university or college education, individuals with less than secondary school education were 13% (adjusted PR 0.87, p < 0.05) less likely to have insurance. CONCLUSIONS: Significant disparities exist in eyeglass insurance coverage in Canada. Individuals with low levels of income and education, and the self-employed, seniors, immigrants, nonwhites, and residents of Quebec had less coverage. Studies are needed to understand whether these disparities contribute to the visual impairment burden in Canada.