Provincial funding at crossroads, optometrists' action to take effect September 1
The Ontario Association of Optometrists (OAO) is not seeing eye-to-eye with the provincial government, and its membership has presented Minister of Health Christine Elliot with an ultimatum. Optometrists will stop accepting Ontario Health Insurance Plan (OHIP)-related eye examination patients on September 1 unless there are substantive changes made to the funding process. Ninety-six percent of OAO doctors voted in favour of the action.
The OAO, which represents 2500 optometrists, argues that the government’s payments don’t even begin to cover basic expenses, noting that in 1989 an optometrist was paid about $39 per exam, and over 30 years later, they only cover an average of about $44 per exam. Eye examinations routinely cost around $88 in overhead expenses, asserts the OAO, even before paying the doctor. OHIP currently covers one annual major eye exam for residents aged 19 and younger, 65 and older, and those with specific medical conditions such as diabetes mellitus and glaucoma.
Under the current budget, optometrists say that they are required to absorb 45 percent of exam costs for OHIP patients, and since seven out of ten patients are covered by OHIP, the funding model is not sustainable. More than four-million eye care services are delivered each year across Ontario.
If nothing changes by the fall, OHIP patients requiring eye exams will effectively be locked out, since provincial legislation precludes optometrists from accepting private insurance or out-of-pocket payments for these services.
Dr. Derek MacDonald, a practicing optometrist in Waterloo since 1992 and a former board member and president of the Ontario Association of Optometrists, cited years of OHIP underfunding, and the need for optometrists to be adequately compensated.
“Over 80 percent of the people I see are OHIP-insured, and the vast majority of my patient load is age 65-plus, the people who are vulnerable to things like diabetic retinopathy and macular degeneration,” MacDonald told the Voice. “These people routinely require both preventative care and treatment for acute and chronic disease.”
MacDonald said that, unlike other regulated healthcare professionals, as well as other occupations like law and teaching, the government doesn't have any formal mandate or obligation to negotiate with the organization.
So we're asking for a regular ongoing negotiation process, and a sustainable funding model
“Discussions happen kind of at the whim of the government, whenever the spirit moves,” said MacDonald. “And that's simply not fair. So we're asking for a regular ongoing negotiation process, and a sustainable funding model.”
Since 2005, asserted MacDonald, “there's been nothing, no increase in funding despite ongoing regular attempts by our association to make contact with the bureaucracy within the Ministry, elected officials, and the Minister herself.”
Optometrists are simply asking for cost recovery, maintained MacDonald, “which, when you think about it, is actually kind of ludicrous. We're not even asking to make money. We're asking to break even.”
MacDonald said that the government is putting a spin on the truth, proclaiming that they have continually increased funding.
“What they mean is that more and more people are becoming OHIP-insured. So yes, the government is paying more money for eyecare. But it's simply a volume issue. They're still paying the same woefully inadequate fee to optometrists.”
MacDonald admits that Christine Elliot, the Provincial Minister of Health, has had a lot on her plate for the past 18 months, dealing with the COVID pandemic. “But this issue has been percolating for three decades—it should have been addressed a long time ago,” he said. “September 1 is coming quickly, and this is going to be a disaster if the government doesn't address the extreme inequity and disrespect that they've been showing our profession for three decades.”
Alexandra Hilkene, Press Secretary for Deputy Premier and Minister of Health Christine Elliott, told the Voice last week that that, “We proposed a comprehensive proposal to the OAO that is fair, sustainable, and effective in supporting optometrists in delivering high-quality care to Ontarians, now and into the future. It is responsive to the OAO’s request for immediate OHIP fee increases, sets out a plan for future fee increases, and a process for the parties to establish an ongoing active dialogue to address any issues that the parties wish to discuss. Now that the OAO has agreed to mediation, we expect them to work with us in good faith to reach an agreement while continuing to deliver the quality care that patients expect and deserve.”