title: Unintended consequences of delisting routine eye exams on retinopathy screening for people with diabetes in Ontario, Canada.
abstract: BACKGROUND
  Routine eye examinations for healthy adults aged 20-64 years were delisted from the Ontario Health Insurance Plan in 2004, but they continue to be insured for people with diabetes regardless of age. We sought to assess whether the delisting of routine eye examinations for healthy adults had the unintended consequence of decreasing retinopathy screening for adults with diabetes.
  
  
  METHODS
  We used administrative data to calculate eye examinations for people with diabetes ages 40-64 years and 65 years and older in each 2-year period from 1998 to 2010. We examined differences by sex, income, rurality and type of health care provider. We used segmented linear regression to assess the change in trend before and after 2004.
  
  
  RESULTS
  For people with diabetes aged 65 years and older, eye examinations rose gradually from 1998 to 2010, with no substantial change between 2004 and 2006. For people with diabetes aged 40-65 years, there was an 8.7% (95% confidence interval [CI] 6.3%-11.1%) decrease in eye examinations between 2004 and 2006. Results were similar for all population subgroups. Ophthalmologic examinations decreased steadily for both age groups during the study period, and there was a decline in optometry examinations for people ages 40-65 years after 2004.
  
  
  CONCLUSIONS
  The delisting of routine eye examinations for healthy adults in Ontario had the unintended consequence of reducing publicly funded retinopathy screening for people with diabetes. More research is needed to understand whether patients are being charged for an insured service or to what degree misunderstanding has prevented patients from seeking care.
authors.affiliation: Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario. tara.kiran@utoronto.ca
authors.forename: Tara
authors.initials: T
authors.lastname: Kiran
authors.forename: Alexander
authors.initials: A
authors.lastname: Kopp
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.forename: J Charles
authors.initials: JC
authors.lastname: Victor
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Campbell
authors.forename: Baiju R
authors.initials: BR
authors.lastname: Shah
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000639:trends; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000639:trends*; D008875:Middle Aged; D009313:National Health Programs / Q000639:trends; D009864:Ontario; D009885:Ophthalmology / Q000639:trends*; D009907:Optometry / Q000639:trends*