The Effect of Government-Uninsured Optometric Services on the Use of Primary Care Providers

INTRODUCTION: Eye care in many countries is provided by optometrists, ophthalmologists, primary care providers (PCPs, including family physicians and pediatricians) and emergency department (ED) physicians. In the province of Prince Edward Island (PEI), Canada, optometric services are not government-insured, while services provided by other eye care providers are government-insured. Clinics of optometrists, PCPs and ED physicians are widely distributed across the island. Clinics of ophthalmologists however are concentrated in the capital city Charlottetown. PURPOSE: To investigate if more patients visited government-insured PCPs and EDs for eye care when local optometric services are government-uninsured and government-insured ophthalmologists are potentially distant. METHODS: From PEI physician billing database, we identified all patients with an ocular diagnosis from 2010–2012 using International Classification of Diseases, 9th Revision (ICD-9) codes. The utilization of government-insured PCPs and EDs in five geographical regions was assessed utilizing patients’ residential postal code. Of the five regions, Prince was the region farthest from the capital Charlottetown. RESULTS: Compared to utilization of government-insured PCPs for ocular diagnoses in Charlottetown (13.5% in 2010, 95% confidence interval [CI] 12.9–14.0%), the utilization in Prince (22.4% in 2010, 95% CI 21.7–23.1%) was nearly double (p<0.05). The utilization of ED physicians for ocular diagnoses was similarly double in Prince (8.8%, 95% CI 8.3–9.3%) versus Charlottetown (4.1%, 95% CI 3.8–4.5%). The utilization of ophthalmologists however was significantly lower in Prince (43%, 95% CI 41.4–42.9%) versus Charlottetown (56.3%, 95% CI 55.6–57.1%). Similar trends remained throughout 2010–2012. CONCLUSION: When optometric services are government-uninsured and government-insured ophthalmologist services are geographically distant, ocular patients utilized PCPs and ED physicians more frequently. Due to different levels of training and available equipment for eye examinations among PCPs, ED physicians and optometrists, the quality of eye care and cost-effectiveness of increased use of PCPs and ED physicians for ocular management warrant further investigation. TRIAL REGISTRATION: Not applicable.