budget_prop_2016_v13

Eye care forevery AustralianFederal BudgetSubmission 2016 –17

lead engage promoteFederal Budget Submission 2016-17© Optometry Australia204 Drummond Street,Carlton VIC 3053p 03 9668 8500e [email protected] www.optometry.org.auFurther information:Genevieve QuiltyChief Executive [email protected] CappuccioNational Policy [email protected]

About Us Optometry Australia is the national peak professional body for optometry, comprising a membership base of almost 90 per cent of registered optometrists in Australia.Our focus is to lead, engageand promote the professionof optometry, optometristsand community eye health.

Overview Optometry Australia welcomes the opportunity to advise key programs to help support community access to primary eye health and vision care services through the 2016-17 Federal Budget. These recommendations are aimed at supporting the delivery and accessibility of primary eye health care for all Australians. Changing social and demographic This imbalance is threatening eye factors such as an ageing population care access for many Australians, and increasing prevalence of chronic particularly those in areas of high social- disease mean the need for timely and disadvantage, children, and middle-aged affordable access to primary eye care Australians. is increasingly vital for all communities. Whilst the cost of providing the high- To address these challenges, Optometry quality optometric care necessary to Australia proposes a number of key meet the changing eye health care needs measures for the Australian Government of the community continues to rise, to implement to ensure that access to Government investment in primary eye primary eye health services is equitable, care has reduced. accessible, and timely.

action Prompt action is needed to ensure optometrists areMore Australians visit able to meet the growingan optometrist than any eye health needs of theother non-medical health community now andprofessional. Over 4,800 in the future.practising optometristsprovided over eight millionprimary eye and vision careservices last year.Recommendations Recommendation Cost at a glance Reinstate annual indexation of the Optometry Medicare Benefits $30.4 million Scheme consistent with CPI. over 3 years All patients between 40 – 65 years be permitted to access $72.2 million a Medicare rebate for a biennial comprehensive eye health over 3 years examination with an optometrist. Introduce a bulk bill incentive for optometry services for $30.8 million patients with a Commonwealth Concession Card and over 3 years children under 16 years of age. All Aboriginal and Torres Strait Islander people be permitted annual $7.29 million access to a Medicare rebate for a comprehensive eye health over 3 years examination with an optometrist, with rebates for subsequent and other consultations as clinically necessary maintained.

Optometry is facing growing economic, demographic and social challenges that threaten the long-term sustainability of primary eye care.Federal Budgetimpacts on theoptometry sectorRecent Measures Current primary health care and MBS reviewsThe last two Federal Budgets have included a number of measures On behalf of the optometry sector,directly relating to the Optometric Medicare Benefits Schedule Optometry Australia is actively(OMBS), which has both positively and negatively affected participating in the reviews of the primarycommunity access to eye care. health care system and Medicare Benefits Schedule (MBS). It is imperative that anyOptometry Australia has welcomed a These cuts to the OMBS and continuation measures arising from these reviews donumber of measures such as the removal and subsequent extension on the freeze not negatively impact patient access toof the cap on fees optometrists can on indexation pose a new threat to optometric care. Further, the reviewscharge for their clinical services1, the service provision, patient access and should not be used as a reason forintroduction of new telehealth OMBS ultimately to population eye health, where inaction in introducing available solutionsitem numbers, and the reduction of the the impact is being disproportionately to help ensure sustainable access toeligibility for a comprehensive eye health borne by those already experiencing primary eye care.examination for patients aged 65 years socio-economic and geographicaland over from two years to one year. disadvantage. While Optometry Australia recognises the challenges in funding primary healthHowever, there have been a number of For those optometrists who provide care, access to optometric care is a keyother measures which threaten the long- the majority of their services to patients component of an effective, efficient andterm sustainability of primary eye health heavily reliant upon bulk billing to access sustainable eye care system and vital toand vision care. These include: care (e.g. those on low incomes, rural/ maintaining vision and eye health for the remote areas), the ability to charge millions of Australians who experience eye• a five per cent cut in the patient rebate patients a fee greater than the amount and vision problems. for optometry consultations under they will be rebated through Medicare is Medicare that came into effect 1 not an approach they can rely upon, given   January 2015 the circumstances of their patients. This is threatening the sustainable provision of• an extension of the freeze on OMBS optometry services and patient access, indexation through to July 2018, particularly in communities with high levels leaving fees not just 5% lower but of social disadvantage, and in some low frozen at 2012 levels. socio-economic and rural and remote areas of Australia.• extending the period for Medicare- eligible comprehensive eye health examinations for asymptomatic patients from two years to three years for all patients aged under 65 years1 Prior to 1 January 2015, optometrists, unlike any other health professional, were unable to charge above the scheduled fee set by the Government, for MBS services.

80%ofvision impairment is treatable or avoidable

Why action to Eye problems are one ofimprove primary the most common healtheye care access complaints with just over 10 million Australians is essential reporting a long-term eye condition.1 Increasing disparity Government expenditure on primary eye health and vision care throughbetween OMBS rebates the OMBS has decreased by around $29.8 million in 2015 compared to the previous year.2 In population terms, OMBS expenditure per patient and the true costs of decreased by 9.1 per cent in 2015. providing eye care Current OMBS fees are not proportionate cost to patients. Unless the government to the cost of providing optometric clinical increases its investment in optometry, care. Patient rebates have not risen in an optometrist will need to pass these over 3 years (since November 2012). additional costs to patients to continue On top of the freeze, the 5% cut to the to provide a sustainable clinical service. OMBS patient rebate means that the In areas where high proportions of the rebate patients can access for optometric community have low incomes this is care has moved further and further away often simply not possible – patients from the real cost of providing quality can’t afford an out-of-pocket expense. clinical eye health and vision care. This creates an unsustainable situation – patients can’t afford out-of-pocket While patient rebates for optometry expenses, yet optometrists can’t sustain services are reducing, the costs of viable practices on bulk-billing alone with providing such services are increasing. reducing patient rebates and increasing Estimates drawn from comprehensive clinical costs. analysis of practice running costs, suggests that the actual cost of providing Impacts are already being felt by a comprehensive optometric consultation patients and practices. A survey by would be $95.00.3 The patient rebate Optometry Australia showed that 28% under the OMBS for these consultations of respondents noticing a decrease is currently $66.80. in health care card holders and children under 16 years seeking eye For a comprehensive eye health care. Optometry Australia assumes examination, Optometry Australia that government only statistics from estimates the current rebate is $13.66 Medicare also attest to this reduction in less than what it should be if fair access. Optometry practices are also indexation had been applied (in line under threat with more than a quarter with CPI each year) since 1998.4 of respondents believing long term Modelling by Optometry Australia implications of these changes may result estimates that practice incomes in the closure of their practice.6 associated with Medicare rebates will be $9,282 less per full time optometrist It was reported that the total cost of vision in 2016 than they would have otherwise loss to the Australian community was been due to the cuts in the OMBS rebate $16.6 billion in 2009.7 With close to 80% and the ongoing freeze on indexation.5 of vision loss preventable or treatable, millions of dollars could be saved if With less income and increased avoidable vision loss was prevented. A operating costs, optometrists are report by Access Economics estimate effectively being left out-of-pocket while that a return of five dollars for every dollar providing the high-quality eye care our invested in preventing avoidable vision communities need unless passing the loss can be achieved.8 2 Optometry Australia. Analysis of Medicare statistics. Accessed online at http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp 3 Based on modelling undertaken by Kilham Consulting. (Commissioned by Optometry Australia) 2015. (Unpublished) 4 Optometry Australia. Position Statement - Remuneration for sustainable primary eye care. September 2014 5 Optometry Australia. Analysis of OMBS expenditure based on the optometry workforce EFTO 2013-14. (Unpublished) 6 Optometry Australia. Member survey report, August 2015 (Unpublished) 7 Access Economics. Clear Focus – The Economic Impact of Vision Loss in Australia in 2009 8 Access Economics. Investing in Sight: Strategic Interventions to Prevent Vision Loss in Australia. 2005

Our Recommendation Optometry Australia calls on the Australian Government to reinstate annual indexation of the OMBS consistent with CPI, to adequately and fairly reflect the increasing cost of providing optometric clinical care. Cost estimate: $30.4 million over 3 years

prevent2 The prevalence of As part of the 2014-15 budget, the Federal Government announced most preventable changes to the frequency with which patients considered ‘asymptomatic’ would be able to access a Medicare rebate for a comprehensive eye or treatable eye health examination, including extending the allowable time period toconditions increases access a comprehensive eye health examination from two yearly to once every three years for patients less than 65 years of age. exponentially after the age of 40 As stated following this announcement, The progressive nature of ocular disease Optometry Australia considers there and its impact on vision should lend itself is no sound evidence to support this to establishing criteria that encourages extension to the allowable time period timely access to preventative eye care to a comprehensive eye examination for for people who reach an age where the patients under 65 years. We are greatly risk of eye and vision problems rapidly concerned that this change will, and increases rather than discouraging already is, negatively impacting upon the regular care. eye health of many Australians. The prevalence of many ocular diseases Best practice, and available evidence increases exponentially with age and demonstrates the need for regular eye the rate of vision loss trebles for each health examinations for the prevention additional decade after 40 years. In and early detection of eye diseases- 2009 there were an estimated 575,000 Optometry Australia and numerous Australians over the age of 40 with some international optometric and ophthalmic form of vision impairment or blindness. bodies recommend at least biennial This is expected to increase to over comprehensive eye health examinations 800,000 by 2020.11 for middle-aged patients, regardless of whether or not they are currently With close to 80% of vision problems experiencing obvious symptoms of avoidable or treatable with early eye and vision problems.9 Research detection, the rate of return on investing shows the rate of undetected ocular in primary eye health and vision care is disease at a population level can be significant. For example, an estimated significant, with many ocular diseases 300,000 Australians have glaucoma, typically not showing any symptoms but only half have been diagnosed.12 in the early stages of progression, For the undiagnosed, they are living with including glaucoma, diabetic retinopathy, the risk of progressive vision loss leading age-related macular degeneration and to possible blindness. The total cost cataract.10 Increasing age, diabetes economic cost of glaucoma is expected and never having had a previous to rise to $4.3 billion by 2025; early eye examination are all predictors of detection and management is key to undetected ocular disease. Denying reducing this cost. asymptomatic patients a Medicare rebate for regular two yearly eye health examinations, puts them at risk. 9 Optometry Australia. Position Statement - Preserving timely access to preventable primary eye care. June 2014. 10 Access Economics. Clear Insight. The Economic Impact and Cost of Vision Loss in Australia. August 2004. 11 Access Economics. Clear Focus – The Economic Impact of Vision Loss in Australia in 2009. 12 Access Economics. The Economic Impact of Primary Open Angle Glaucoma. 2008

Our Recommendation All patients between 40 – 65 years be permitted access to a biennial comprehensive eye health examination with an optometrist, as was the case prior to December 2014. This is based on empirical evidence and best practice for the early detection of eye disease and prevention of vision loss and blindness. Cost: $72.2 million over 3 years

costaccess3 Current OMBS Australians on a low income Addressing access issues rebates mean that bulk billing Whilst people living in low socio General practitioners and diagnosticAustralians with low economic areas often experience imaging providers are given incentivesincomes and people high rates of eye and vision problems, through the MBS to bulk bill under 16 years old for many the cost of healthcare is a Commonwealth Concession Cardis unsustainable for significant barrier to accessing services holders and children under 16 years optometrists in a timely manner. As highlighted above, of age. decreases in the OMBS rebate and rising costs of providing optometric care Optometry Australia proposes that a are further threatening access for these bulk bill incentive should be extended vulnerable groups. Whilst to maintain to optometry services to patients with a a sustainable business many practices Commonwealth Concession Card and need to introduce fair fees for their children under 16 years of age. This services, many low-income Australians would support ongoing access for low can’t afford out-of-pocket health costs. income Australians and children under In low socio economic areas this paradox 16 years of age to eye care. is already threatening sustainable patient access to eye care. Measures need to be implemented to ensure timely access to primary eye care for low-income Australians. Australians under 16 years of age Good vision is important for a child’s educational, physical and social development. With approximately 1 in 5 Australian children either suffering from an undetected vision problem or requiring ongoing assessment,13 it is important to be aware of the possible signs of a vision problem to give every child the best chance of reaching their full potential. It is important that children have a full eye health examination with an optometrist before starting school and regularly as they progress through primary and secondary school. 13 J unghans B, Kiely PM, et al. Referral rates for a functional vision screening among a large cosmopolitan sample of Australian children. Ophthalmic Physiol Opt 2002; 22: 10–25.

Our Recommendation Optometry Australia calls on the Australian Government to introduce a bulk bill incentive for optometry services at a rate of 10 per cent of the OMBS patient rebate, for patients with a Commonwealth Concession Card and children under 16 years of age. Cost: $30.8 million over 3 years

4Aboriginal and Torres Next year marks ten years since Of great concern is that 35% of allStrait Islander people the launch of the Close the Gap Aboriginal and Torres Strait Islander campaign, which committed Australian adults have never had a comprehensive continue to face Governments to supporting the eye health examination by an eye barriers accessing realisation of equality for Indigenous health professional. primary eye health people in health and life expectancy. While there have been improvements Optometry Australia calls on the and vision care in some health outcomes, Aboriginal Australian Government to take further and Torres Strait Islander people still strides in closing the gap, particularly experience six times the rate of low in the delivery of eye health care to vision and 2.8 times the rate Aboriginal and Torres Strait Islander of preventable blindness, as people. By facilitating regular access non-Indigenous Australians.14 to eye health exams for Indigenous Australians, quality of life and eye health can be improved.closingthe gap 14 Professor Hugh Taylor AC et al. National Indigenous Eye Health Survey. September 2009.

Our Recommendation Optometry Australia recommends that Aboriginal and Torres Strait Islander people be able to access a Medicare rebate for a comprehensive eye health examination with an optometrist each year, with maintained rebates for subsequent and other consultations as clinically necessary. Cost: $7.29 million over 3 years

By implementing our recommendations $140.68m, the federal government can generate a positive and almost immediate impact on the eye health of millions of Australians, whilst reducing the ecomonic burden of vision impairment.© Optometry Australia p 03 9668 8500204 Drummond Street, e [email protected] VIC 3053 w www.optometry.org.au