Around a quarter of Australian eyecare patients are avoiding treatment for their condition due to cost reasons, according to new research that points to the impact of declining Medicare rebates and a mismatch between subsidised care and practising patterns.
The study, published in the latest issue of Public Health Research & Practice, a peer-reviewed journal of the Sax Institute, surveyed patients attending collaborative eyecare clinics where optometrists provide diagnostic imaging and services typical of public hospitals or large private ophthalmology practices.
Patients faced significant financial barriers, with 36.8% reporting that they did not obtain services prescribed by an optometrist due to costs. One or more direct or indirect cost barriers were experienced by 42.6% of respondents for optometric care, and 40.4% for specialist eyecare.
Patients with poorer self-rated health or lacking private hospital health insurance were the hardest hit.
“Our findings underline the considerable cost barriers people face when accessing eyecare,” said senior author Dr Angelica Ly, a researcher at the School of Optometry and Vision Science at UNSW Sydney.
“We found that on average, one in four patients were opting not to access eyecare services because of the cost, even after attending a collaborative care clinic that provides services at no cost to patients. And nearly half reported cost as a barrier when seeking eyecare. Our research shows that more support is needed, especially for people with poor self-rated general health or without private hospital health insurance.”
The findings come as the industry continues to highlight the declining real value of Medicare rebates, contributing to a considerable uptick in out-of-pocket costs for eyecare services during the past decade, the authors say.
According to the study, patient expenditure on eyecare has increased significantly over the past 10 years. Fees recommended by Optometry Australia are currently $65–$132, yet the corresponding Medicare rebates are only AU$35.55–$70.55.
The average inflation-adjusted copayment for optometry services increased by more than $30 from 2010 to 2020, they note, and the median out-of-pocket fee for specialist services is currently $96. At the same time, use of optometric services is high, with 82% of Australians having undergone an eyecare test in the previous two years.
Another potential reason for increased out-of-pocket costs, according to the study, is that Medicare coverage of services does not adequately reflect utilisation patterns. For example, at least 55% of optometrists use retinal imaging daily to detect and monitor eye diseases to reduce the risk of vision loss, which is supported by clinical care guidelines. In this application, however, retinal imaging costs as much as $120 out-of-pocket per visit and can support early intervention, yet it does not attract a Medicare rebate.
“Overall, these findings indicate that current collaborative eyecare models may be improved by providing additional support for individuals who are in poorer health or do not have private health insurance. Additionally, public health policies need to use eyecare-specific strategies to optimise access to eyecare,” the authors said.
This edition of Insight has a focus on the increasing strain on optometry providers to provide bulk billed eyecare (page 31). Currently, the profession boasts one of the highest bulk billing rates (94%), but the rising operational costs – and indexation freezes – are creating tough conditions to continue offering this sustainably.
Optometry Australia has recently stated estimates drawn from comprehensive analysis of practice costs indicate the actual cost of providing a comprehensive consultation in a sustainable business model is over $50 more than the Medicare scheduled fee.
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