Optometry services have been subsidised by the Australian Government since Medicare (then Medibank) was first introduced in 1975. This has long been considered a significant win for the profession, and for population eye health, given the limited number of non-medical professions able to access subsidies for patient care without a referral from a medical practitioner.
Medicare rebates for optometric services have been critical in ensuring a breadth of Australians have access to affordable primary eyecare, and are arguably central to the high uptake of optometric care in Australia; in 2022 alone, 10.6 million optometry consults were billed to Medicare, suggesting a return to the steady pre-COVID growth trajectory. This not only helps to enhance or maintain quality-of-life for people with correctable vision, but in supporting early detection and treatment of eye conditions, it reduces the overall burden on the healthcare system.
Skye Cappuccio.
Arguably the fee-for-service model, if funded adequately, remains a good fit for many to optometry.
Unfortunately, for well over a decade there has been an increasing misalignment between the true costs of providing optometric care and the Medicare rebates for these services. Medicare rebates for optometry – and for many other clinical services – were frozen from November 2012 to November 2014, reduced by 5% in 2015 and then further frozen prior to the reintroduction of indexation (after advocacy from Optometry Australia) in 2019. As a result of all these factors, Medicare scheduled fees for optometric services are now less in actual dollar terms than they were in 2012.
The fact that reducing the real value of Medicare rebates is not an issue that is unique to optometry is cold comfort.
Despite this, we have seen optometry retain some of the highest bulk-billing rates of any profession; they consistently hover around 94%. This is partly historical – prior to the removal of the cap on fees, optometrists could charge under Medicare after extensive association lobbying in 2015, and it was often considered that there were limited benefits in accepting the additional administrative burden to charge a marginally higher fee. Since the fee cap removal, bulk-billing rates have reduced only minimally, due to the increased level of competition in the sector and cross-subsidisation of clinical care with sales of glasses and contact lenses.
The combination of inadequate rebates, high bulk-billing rates and a (necessary) reliance on retail to cross-subsidise clinical care has multiple impacts. Whilst bulk-billing rates remain incredibly high, the likelihood of government recognising a need to increase rebates or employ fairer indexation is low. This system also builds in a disincentive to provide too many services not likely to be associated with a prescription for glasses or contact lenses, as it’s simply not a financially viable option when bulk-billing. This is problematic when, due to an ageing population and an over-burdened tertiary sector, the need to support optometrists to provide greater volumes of complex care and care for chronic eye diseases is increasing.
The current funding approach is not structured to support a readily accessible and robust primary eyecare system with optometrists working to their fullness of scope, and into the future. Optometry Australia will continue to call on the government to undertake a comprehensive, independent review of Medicare scheduled fees for optometric items, and join the call from a breadth of health professional associations for fairer Medicare rebates.
However, as a sector we also need to begin exploring alternate funding models, ones that also support optometrists to work to their fullness of scope and provide ongoing management of complex, and often chronic, presentations.
Across the country there are dotted successful practices who choose not to bulk-bill and charge fairer fees for their clinical care. This, however, is not sustainable in all demographics, given for some patients, their out-of-pocket costs remain an obstacle to accessing care.
It is encouraging to see the government recognising the limitations of the fee-for-service Medicare model, and exploring blended funding models that complement fee-for-service with other approaches. However, at this point, this conversation is primarily focused on GP care and supporting GP-led care with allied health care.
As a sector, it’s vital that we begin exploring what future funding models for a sustainable primary eyecare system look like. This should not mean abandoning Medicare – arguably the fee-for-service model, if funded adequately, remains a good fit for many presentations to optometry. But it should mean lifting our eyes from Medicare as the only possible approach to funding eyecare.
ABOUT THE AUTHOR Name: Skye Cappuccio
Qualifications: BA, PgradDPH, GAICD
Affiliations: Optometry Australia
Position: Interim CEO
Location: Canberra
Years in industry: 10+ years
