Medicare has played a vital role in supporting relatively good community access to optometric care for decades. The structure of Medicare Benefits Schedule (MBS) items shape what eyecare Australians access.
To ensure we maintain and enhance community access to much-needed primary eyecare, Australia cannot afford to wait – we must ensure that Medicare continues to evolve to best support eye health and vision care needs.
In recent years, optometrists have been telling us that they have been seeing a decline in initial comprehensive eye examinations for asymptomatic younger and middle-aged patients. This is of great concern – we know that these patients may have, or be at risk of, ocular conditions that do not currently affect their sight, but can result in vision impairment or vision loss if not identified early enough to be managed effectively.
Optometry Australia undertakes comprehensive analysis of MBS billing data every six months. While we have seen increased year-on-year inconsistency in billing data as a result of the COVID-19 pandemic, over recent years there has been a significant fall in the numbers of Australians aged under 65 receiving initial comprehensive eye examinations.
Per capita initial comprehensive eye examinations reduced 18.1% nationally for people under 65 between 2017-18 and 2023-24. All age cohorts from 0-5 years to 55-64 years have reduced. The raw number of Australians aged under 65 getting Medicare-subsidised initial comprehensive eye examinations fell 12.4% from 2017-18 to 2023-24. Critically, if the 2017-18 per capita rate for under 65s was maintained in 2023-24, there would have been an additional 424,000 initial comprehensive eye examinations.
In terms of enhancing access to primary eyecare, Medicare data shows that Australia is going backwards.
There are likely multiple reasons for this disturbing drop-off. The 6.2% reduction in per capita initial comprehensive eye examinations between 2022-23 and 2023-24 indicates that cost-of-living issues may be having an impact. Also understandably, numbers fell during COVID. We recognise that optometrists may be making greater use of other MBS items for progressing eye conditions (particularly in older patient cohorts), however, analysis shows a reduction in per capita usage of all comprehensive eye exams.
The most significant contributor is likely the change introduced by the Federal Government in 2015, to reduce the frequency with which people under 65 years can access a rebate for an initial comprehensive examination from two to three years.
This change was strongly opposed by Optometry Australia when first announced; we argued that it was inconsistent with good practice. The Optometry Clinical Committee of the MBS Review Taskforce subsequently recommended altering it to support more frequent access for middle-aged Australians.
Australians should be as concerned as we are that asymptomatic Australians aren’t accessing the regular eyecare they need. Projections show that the greatest increase in the absolute number of Australians with vision loss is expected between 2020 and 2030. We must address the root cause – not enough Australians accessing comprehensive eye examinations to enable early identification of – and effective intervention in – eye disease and vision problems.
As we head toward a Federal Election, Optometry Australia is calling on all major parties to commit to supporting Medicare rebates that enable all Australians under 65 to access a rebate for a comprehensive eye examination at least every two years. This is in the interests of patients, population health and the profession. Our advocacy efforts are well under way, and in the coming months, we will be calling on optometrists and stakeholders to support our efforts. Collectively, we have a responsibility to ensure Medicare items evolve to support the best outcomes for our communities.
ABOUT THE AUTHOR
Name: Skye Cappuccio
Qualifications: BA, PgradDPH, GAICD, MBA
Affiliations: Optometry Australia
Position: CEO
Location: Canberra
Years in industry: 10+ years
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