title: Health insurance coverage and use of eye care services.
abstract: OBJECTIVE
  To compare realized access or use of eye care services in adults with self-reported vision problems in Canada and the United States.
  
  
  METHODS
  Using the Joint Canada/United States Survey of Health, we examined the differences in use of eye care services in 2018 Canadian respondents and 2930 American respondents with self-reported vision problems. We performed multivariate logistic regression analyses to estimate the probability that individuals with vision problems and various insurance categories would visit an eye care professional.
  
  
  RESULTS
  Approximately 8.2% of Americans with self-reported vision problems did not have health insurance. Americans without health insurance had the lowest age-adjusted rate of use of eye care services (42%) compared with Americans with private health insurance (67%) or public health insurance (55%) and Canadians (56%). The difference in use of eye care services between Americans without health insurance and Canadians narrowed when adjusted for income level and was almost eliminated when adjusted for having optional vision insurance. Individuals with optional vision insurance and those with higher income levels were more likely to use eye care services.
  
  
  CONCLUSIONS
  Americans with vision problems who had health insurance accessed eye care services at a rate higher than or equal to that of their Canadian counterparts. The gap in access between Canadians and Americans without health insurance narrowed after adjustments for income level and optional vision insurance.
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailbox K-10, Atlanta, GA 30341-3727, USA. XZhang4@cdc.gov
authors.forename: Xinzhi
authors.initials: X
authors.lastname: Zhang
authors.forename: Paul P
authors.initials: PP
authors.lastname: Lee
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Thompson
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
authors.forename: Lawrence
authors.initials: L
authors.lastname: Barker
authors.forename: Linda S
authors.initials: LS
authors.lastname: Geiss
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Imperatore
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
authors.forename: Xuanping
authors.initials: X
authors.lastname: Zhang
authors.forename: Jinan B
authors.initials: JB
authors.lastname: Saaddine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006302:Health Services Research; D006306:Health Surveys; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014786:Vision Disorders / Q000453:epidemiology* / Q000628:therapy