Canada has a national health care system composed of thirteen interlocking provincial health insurance plans to ensure that all residents have access to necessary hospital and physician services.(1) The federal government, the ten provinces, and the three territories have key roles to play in the health care system. Canada’s national health insurance program, often referred to as "Medicare", is 70% financed from public sources and 30% from private sources.
The responsibilities for Canada's health care system are shared between the federal and provincial governments. Under the Canada Health Act (CHA), the federal health insurance legislation, criteria and conditions are specified that must be satisfied by the provincial and territorial insurance plans. Local governments are responsible for the management, organization and delivery of health services for their residents, and the federal government provides the funds. When Canadians need health care, they generally contact a primary health care provider such as a family doctor, nurse, nurse practitioner, etc. Services provided at the first point of contact are known as primary health care services and form the foundation of the health care system. In general, primary health care serves a dual function; it provides a gateway to health care services and coordinates patients' care to ensure continuity and movement across the health care system. A patient may be referred to a specialist at a hospital.
General public health insurance covers medical payments for eye injury and various eye diseases such as cataract, glaucoma, and diabetic retinopathy. Optional/supplemental vision insurance provides additional insurance coverage for eye examinations, contact lenses, eyeglasses and/or frames, and, in some instances, part of the costs for elective laser surgery for vision correction.
The “Optometric Benefit” in Nova Scotia provides insurance for visual analysis carried out by optometrists.(2) Vision analysis is defined as: “an examination that includes the determination of: 1) the refractive status of the eye; 2) the presence of any observed abnormality in the visual system, and all necessary tests and prescriptions connected with such determination.” This benefit is limited to one routine vision analysis every two years for those under 10 years of age and those 65 and over. Those between 10 and 65 are not covered for routine check-ups, but are covered where medical need is indicated. Furthermore, under the Children’s Drug and Optical Program, eligible low-income families are assisted with the cost of prescription drugs, eye exams and eye glasses for children 18 and younger.
A literature review of existing Canadian policy on vision care and low vision services identified barriers to access.(3),(4),(5) These barriers include: an ongoing growth in demand for services within a context of limited resources; gaps in provincial health plan coverage for vision services; a need for increased cooperation between providers; a need for increased awareness on the part of ophthalmologists, optometrists and family physicians of existing vision rehabilitation availability and benefits; and a need to promote greater compliance with referrals on the part of consumers. (6) This review implies that Canada has:
Current data regarding the causes and prevalence of low vision and blindness in Canada are weak, as no recent population-based studies have evaluated the ocular health of Canadians. (7),(8) Eye care in Canada is typically administered in the community setting and, as such, prevalence evaluations of blindness and low vision cannot be gleaned from hospital or institutional databases. Furthermore, the diagnostic codes that are submitted to Provincial Medical Service Plans vary tremendously in detail and accuracy.
Results from the Joint Canada/United States Survey of Health in 2002 concluded that residents in the two countries have similar health status and access to care, although there are higher levels of inequality in the United States.(9) In Canada, the burden of vision problems and difficulty ensuring that residents have access to regular eye care services and corrective lenses are comparable to those in the United States. Although Canada and the United States share an open border and are similar in many ways, their health care financing systems differ substantially, which impacts rates of health care utilization.
One study found that among adults with vision problems, the rate of use of eye care services was higher among Americans with private health insurance than among their Canadian counterparts.(10) However, it also found that Americans without health insurance were less likely than Canadians to have optional vision insurance. Previous studies have shown health insurance is positively associated with access to eye care services(11) and that Canadians and Americans with health insurance utilize services at about the same rate, but Americans without health insurance are less likely to visit a physician and have significantly higher unmet health care needs.(12)
“Although health insurance is associated with increased use of preventive services and recommended treatments, simply providing health insurance to all persons may be insufficient to increase the %age of individuals who use eye care services or to improve vision-related outcomes; economic status and optional vision insurance are also significantly associated with rates of use of eye care services.(13) Results of a study from Australia showed that despite universal insurance coverage, nearly half of patients with diabetes did not visit eye care professionals for screening or follow-up of diabetic retinopathy.” (14)
(1) Health Canada. Canada's health care system (Medicare). Accessed October 26, 2009.
(2) Canada Health Act. Annual Report 2007-2008. Accessed 27 October 2009.
(3) R.K. Koenekoop, J.E.S. Gomolin, Th management of age-related macular degeneration: patterns of referral and compliance in seeking low vision aids, Can. J. Ophthalmol. 30 (1995) 208– 210.
(4) V. Kozousek, et al., Use of ophthalmologic services by diabetic patients in Nova Scotia, Can. J. Ophthalmol. 28 (1) (1993) 7 –10.
(5) Government of Canada, Waiting for Romanow: Recommendations on the Future of Canada’s Health Care, National Advisory Council on Aging, Ottawa, 2002.
(6) Gold, Deborah; Zuvela, Biljana. The impact of health policy gaps on low vision services in Canada. International Congress Series 1282 (2005) 134–138
(7) Hameed TK, Hodge WG, Buhrmann R. An inventory of information on blindness and visual impairment in Canada. Can J Ophthalmol 2001; 36: 175–185.
(8) Maberley D. Discussion: an inventory of information on blindness and visual impairment in Canada. Can J Ophthalmol 2001; 36: 185–186.
(9) Sanmartin, C. et al. Comparing Health And Health Care Use In Canada And The United States Health Affairs, 25, no. 4 (2006): 1133-1142.
(10) Maberley DA, Hollands H, Chuo J; et al. The prevalence of low vision and blindness in Canada. Eye. 2006;20(3):341-346.
(11) Zhang X, Saaddine JB, Lee PP; et al. Eye care in the United States: do we deliver to high-risk people who can benefit most from it? Arch Ophthalmol. 2007;125(3):411-418.
(12) Sanmartin C, Ng E, Blackwell D, Gentleman J, Martinez M, Simile C, Statistics Canada; US National Center for Health Statistics. Joint Canada/United States Survey of Health, 2002-20032004. Ottawa, ON: Statistics Canada; Catalogue publication 82M0022-XIE.
(13) McCarty CA, Lloyd-Smith CW, Lee SE, Livingston PM, Stanislavsky YL, Taylor HR. Use of eye care services by people with diabetes: the Melbourne Visual Impairment Project [published correction appears in Br J Ophthalmol. 1998 May;82(5):591]. Br J Ophthalmol. 1998;82(4):410-414.
(14) Zhang, Xinzhi. Health Insurance Coverage and Use of Eye Care Services Arch Ophthalmol. 2008;126(8):1121 1126.