The Observatory

Optometrists, patients and communities short-changed in Federal Budget

While this week’s Federal Budget was clearly intended to demonstrate the Government’s commitment to Medicare, its commitment to eye care access fell short.

The Government announced a series of measures under the title of Guaranteeing Medicare, including a staged approach to lifting the long-standing freeze on Medicare rebates. Indexation will be reintroduced to GP bulk billing incentives from 1 July 2017, then standard GP and specialist consultations from 1 July 2018, followed by allied health consultations and specialist procedures from 1 July 2019, and imaging and other services from 1 July 2020.

For optometry consultations this will mean a re-introduction of indexation in mid-2019, just 12 months earlier than previously announced. While this new deadline is marginally better than the previous target that the Government had set, it is far from a win for eye health.

When the freeze is finally lifted for optometry Medicare items in 1 July 2019, these items will have gone without indexation for almost seven years. In fact, patient rebates for optometry services are lower now than they were in 2012. Optometry rebates were last indexed in 2012. Compounding this, there was an across-the-board cut to the patient rebate for all optometry services in 2015.

Since 2015, Optometry Australia estimates that the freeze and the cuts to rebates for optometric care have reduced Government investment in primary eye care by $103 million. This has an impact on the ground for patients and optometry practices. It hits hardest in the many practices throughout Australia where patients rely heavily on bulk billing for affordable care.

A man having an eye examination

Photo caption: a man having an eye examination.

Estimates drawn from a comprehensive analysis of the costs of running a practice suggest that the actual costs of providing a comprehensive eye examination within a sustainable business model exceed the Medicare rebate by up to $30 per consultation. As rebates continue to fall behind the real cost of providing comprehensive clinical care, the struggle to survive for practices providing care in these communities will remain real. A survey of practice owners undertaken by Optometry Australia has shown that many believe that the long-term implications of the extended freeze could ultimately include the closure of their practice.

If practices aren’t sustainable, communities may lose ready access to primary eye care. Yet, while fees above the Medicare patient rebate may be well justified, for many patients, out-of-pocket health care costs simply aren’t an affordable option.

This week’s announcement does little to redress this catch-22 situation for optometrists and their patients.

Over 12 million Australians are living with a long-term eye condition. Eye health and vision problems carry an overall cost to the Australian economy of more than $16 billion annually. Yet, 90 per cent of all vision impairment in Australia is preventable or treatable if detected early, and Access Economics estimate a return of $5 for every $1 invested in preventing avoidable vision loss.

As a point of comparison, Optometry Australia’s estimate is that reinstating indexation to patient rebates for optometry services immediately from 1 July 2017 – when indexation for the bulk-billing incentives for GPs will be indexed – would cost the Australian Government less than $35 million.

This week’s budget announcement represents a missed opportunity for the Australian Government to help ensure our primary eye care system remains sustainable, to help ensure that all Australians can access the primary eye care they need, and that we reduce the impact of avoidable vision loss. Among much talk of the commitment to Medicare and universal health care, the actual investment in primary eye care means universal access remains at threat.

Optometry Australia will continue to lobby the Government to lift the freeze for optometry services immediately, and as a matter of urgency. For the six million Australians who saw their optometrist last year, that’s a lot of eyes looking at the Government!

See Vision 2020 Australia’s full 2017-18 Federal Budget analysis and commentary