Can eye care in Ontario get worse? I can’t see how
Province doing horrible job of funding system
Eye care in Ontario is a mess. The Doug Ford government didn’t create the problem, but it’s going to have to fix it.
The province’s optometrists are demanding higher pay and have withdrawn Ohip-covered services for seniors and children. In the Catch-22 world of Canadian medicare, patients can’t pay for the service directly because it’s covered by OHIP, even when it’s not being provided under OHIP.
In addition, eye surgery conducted by ophthalmologists is severely backed up due to the pandemic. The backlog, mostly for cataracts, makes up more than onethird of Ontario’s total surgical queue, according to the province’s financial accountability officer. This is a problem that will take years to fix.
The ophthalmologists also say they are underpaid, receiving just under $400 from the government for a cataract surgery that used to pay them $535. The Ontario rate is the lowest in Canada, the Eye Physicians and Surgeons of Ontario say.
Eye care is a microcosm of what’s wrong with Canada’s approach to medicare, and it starts with the Canada Health Act, medicare’s foundational document. The health act doesn’t mandate any eye care except for emergencies. Presumably, federal politicians don’t believe that the eye is an important part of the human body. As a result, some provinces don’t cover eye care. Most, like Ontario, provide coverage for seniors or children.
Ontario is doing a remarkably poor job of funding the limited eye care it does offer. The dispute with the optometrists is a case in point. Optometrists are not physicians, but they are trained eye specialists who conduct eye exams, prescribe glasses and monitor care. Ontario optometrists get about $45 for an eye exam, a figure than has changed little in 30 years. The Ontario Association of Optometrists says the checkup costs them about $80 to provide, so they lose money with every service. That’s a big deal when Ohip-covered eye exams make up about 70 per cent of your business.
To put Ontario’s fees in context, the next lowest fee is in Manitoba, which pays $77 for an exam. The Ontario optometrists say they’d be satisfied with that number.
So far, Ontario has offered to boost its fee to $49 and is providing a $39-million retroactive payment, about $16,000 each for the province’s 2,500 optometrists. The optometrists say that doesn’t cut it, and they’re right, as odious as their withdrawal of services for children and seniors is.
In comparison to other health system cost pressures, fixing the optometrist situation is not overly expensive. Optometrists provide about four million exams a year. Meeting their demand would cost something in the neighbourhood of $140 million.
The ophthalmologists are a whole different problem. To start with, there aren’t enough of them. The number of ophthalmologists has not kept pace with population growth over the last decade, much less with increasing demand from an aging population. The ophthalmologists say the volume of work they do has increased by 36 per cent since 2005 but the workforce has only gone up by five per cent. That is somewhat offset by modern technology that allows them to do far more procedures in a day.
The higher volume and limited physician supply has boosted ophthalmologists’ earnings substantially. Between 2011 and 2018, nine of the province’s top 20 billing doctors were ophthalmologists.
The ophthalmologists certainly aren’t suffering as much as their patients. For older people awaiting cataract surgery, the ophthalmology situation is more than an annoyance. Cataracts can sharply reduce vision, affecting seniors’ quality of life, their ability to drive and their independence.
The provincial government is trying to reduce the cataract surgery backlog by taking the unusual step of appealing to private eye clinics to deliver the surgeries at OHIP rates, something they already do in theory. The private clinics provide services beyond the OHIP cataract basics, but the provincial government says no fees can be charged for “medically necessary” cataract surgery. Be that as it may, people willing to pay between $3,000 and $5,000 an eye for the extras can get their eyes fixed much more quickly than those in the OHIP queue.
The government says some have agreed to do so, but human nature suggests that getting 10 times the amount by charging directly will limit the eye docs’ enthusiasm.
It’s difficult to see how eye care in Ontario can get worse than it is now. Seniors can’t even get their eyeglass prescriptions updated and many are waiting for cataract surgery that’s far in the future. Their alternative is to spend an onerous amount of money to get this government-covered service sooner. Surely Ontario can do better.
EYE CARE IS A MICROCOSM OF WHAT’S WRONG WITH CANADA’S APPROACH TO MEDICARE.