title: Does government assistance improve utilization of eye care services by low-income individuals?
abstract: OBJECTIVE
  To examine whether government-funded, low-income vision care programs improve use of eye care services by low-income individuals in Canada.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  27,375 white respondents to the Canadian Community Health Survey (CCHS) Healthy Aging 2008/2009.
  
  
  METHODS
  Government-funded, low-income vision care programs were reviewed. The amount of assistance provided was compared with professional fee schedules for general/routine eye examinations and market prices for eyeglasses. The utilization of eye care providers was derived from the CCHS.
  
  
  RESULTS
  To receive low-income vision care assistance, individuals must be in receipt of social assistance. Criteria for receiving social assistance are stringent. The Canadian Financial Capability Survey revealed that 7.9% of Canadians aged 45 to 64 years and 5.5% aged ≥65 years received social assistance in 2009. The CCHS found in 2008/2009 that 12.5% of citizens aged 45 to 64 years and 13.2% of those aged ≥65 years had difficulty paying for basic expenses such as food. In 5 provinces, low-income vision care assistance fully covers a general/routine eye examination. In the remainder, the assistance provided is insufficient for a general/routine eye examination. The assistance for eyeglasses is inadequate in 5 provinces, requiring out-of-pocket copayments. Among middle-aged whites who self-reported not having glaucoma, cataracts, diabetes, or vision problems not corrected by lenses, utilization of eye care providers was 28.1% among those with financial difficulty versus 41.9% among those without (p < 0.05), giving a prevalence ratio 0.68 (95% CI 0.57-0.80) adjusted for age, sex and education.
  
  
  CONCLUSIONS
  Despite government assistance, low-income individuals use vision care services less often than wealthy individuals.
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Hong
authors.affiliation: Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto.
authors.forename: Graham E
authors.initials: GE
authors.lastname: Trope
authors.affiliation: Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto.
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Buys
authors.affiliation: School of Optometry, University of Waterloo, Waterloo.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Robinson
authors.affiliation: Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto; Department of Ophthalmology and Vision Sciences & Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.. Electronic address: yaping.jin@utoronto.ca.
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Jin
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D003430:Cross-Sectional Studies; D005260:Female; D006078:Government Programs; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D008297:Male; D008483:Medical Assistance / Q000706:statistics & numerical data*; D008875:Middle Aged; D009313:National Health Programs; D009885:Ophthalmology / Q000706:statistics & numerical data*; D009907:Optometry / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data*; D055815:Young Adult