Opinion: Eye care in Ontario is under threat

Optometry is drastically underfunded in this province, and it’s finally reaching a breaking point.

Ottawa Citizen 3 minute read June 22, 2021

Patrick Monaghan's daughter's first eye exam (through OHIP) several years ago when she was six months old. The optometrist in the picture is Monaghan's colleague Dr. Lora Lee Hardy, at Barrhaven Optometric Centre. Patrick Monaghan / Supplied

A crisis has been brewing for more than three decades in Ontario, and it may be a surprise to a lot of people. Access to eye care for a large percentage of the population could be at risk unless something changes. Optometry is drastically underfunded in this province, and it’s finally reaching a breaking point.

The Ontario Association of Optometrists has tried many times to work with provincial governments to improve the way eye care is funded (and ultimately the quality of eye care that could be provided), but the funding rates have hardly changed over the last 30-plus years.

Eye care never seems to be a priority for the provincial government. But wait a minute: doesn’t OHIP cover eye exams for a lot of people? Not so much.

The amount paid by the government for an OHIP-insured patient doesn’t even come close to covering the costs an optometrist’s office faces for time (including staffing costs, utilities, equipment, etc.).

Back in 1989, the government paid $39.15 to cover an eye exam. In 2021 (32 years later), the average payment is only $44.65. A $5 increase … in 32 years.

It’s gobsmacking just to think about that.

As you can imagine, operating costs to perform an eye exam have increased a lot more than $5 in the last 30-plus years.

What’s more, it’s illegal for an optometrist to charge the patient anything extra for an eye exam that’s “covered” by their health card.

This means that for any OHIP-insured patient an optometrist sees, which is about 70 per cent of the average patient base, their office loses money each time, because it is subsidizing the cost to provide care to that patient.

The government is failing to cover the actual cost of service, and making it impossible for optometrists to make up the balance for those “OHIP-covered” exams.

Would you expect a restaurant to keep an item on the menu that costs more than it can charge to provide it? What if most of the people coming into the restaurant were there to order that specific dish? How long do you expect that item to stay on the menu?

Without a mechanism to cover the cost to provide the service, there’s no feasible way to continue providing it. That’s where things have landed with optometrists in Ontario.

Come Sept. 1, if the provincial government doesn’t make strides to fix this broken system, optometrists across Ontario are prepared to take a stand — by withdrawing all OHIP services.

It’s not a step optometrists will take lightly, as they want to continue providing a high level of care to all of their patients, regardless of their age or coverage. But if it’s not financially viable to keep doing that, access may start disappearing.

Change is needed, and it is well within reach. Optometrists simply want a formal negotiation process with the government to come to a funding solution that covers the costs required to provide care. I think most would agree this is a reasonable request.

Other regulated health professions already have this kind of negotiation system in place, ensuring regular formal talks to set fees for OHIP-insured care. Inflation and rising operating costs necessitate increased payments over time.

Optometrists have not been given this critical mechanism, which has resulted in the widening gap between costs and reimbursement over the last three decades.

Routine preventative eye care, especially for the most vulnerable populations, is so important, and yet has been devalued again and again by successive provincial governments.

It’s time for the current government to step up and help address this issue once and for all. Access to eye care in Ontario depends on it.

Patrick Monaghan is an optometrist practising in Ottawa, and a father to two children with autism. Twitter handle: @drpmonaghan


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