Seniors Matter(s): I can see clearly now!

I can see clearly now! Oops, no I can’t.

My articles have, so far, been general in nature so readers can glean knowledge of things that affect seniors.

This article jumps right into a huge dilemma that is affecting all seniors and children in Ontario. I try to lay no blame, yet my research shows a consistency of under-funding by the Government of Ontario to support public services.

There is a major war going on between the Ontario government and optometrists. It seems that eye care in Ontario is a mess. Premier Doug Ford’s government didn’t create the problem, but it’s going to have to fix it.

Ontario's optometrists are launching an urgent appeal to the Ontario government to end the 30-year neglect in funding for eye care. This chronic under-funding, coupled with the devastating impact of COVID-19 on optometrists' ability to see patients, threatens Ontarians' access to these essential health services.

Over the past 30 years, the Ontario government has done a remarkably poor job of funding the limited eye care it does offer, compared to other provinces. 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 that has changed little in 30 years.

The Ontario Association of Optometrists says the check-up costs about $80 to provide, so optometrists lose money with every service. That’s a big deal when OHIP-covered eye exams make up about 70 per cent of their business. Seniors and children have been unable to get adequate eye support because the Ontario Association of Optometrists has withdrawn service to these two age groups in an attempt to escalate a solution.

The next lowest fee is in Manitoba, which pays $77 for an exam. The Ontario optometrists say they’d be satisfied with that number. Surely, Ontario can do better than it is now.

The province’s optometrists have been demanding higher pay and have withdrawn OHIP-covered services for seniors and children.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.

Furthermore, eye surgery conducted by ophthalmologists is severely backed up due to the pandemic. The backlog, mostly for cataracts, makes up more than one-third of Ontario’s total surgical queue, according to the province’s financial accountability officer. This is a problem that will take years to fix.

To me, this eye care dilemma 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.

I understand that 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.

In comparison to other health-system cost pressures (doctors, nursing PSWs, hospitals, emergency care), fixing the optometrist situation is not overly expensive. Optometrists provide about four-million exams per year. Meeting their demand would cost something in the neighbourhood of $140-million.

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.

“We’re not suggesting that that should be the only payment,” said Ontario health minister Christine Elliott said. “We don’t expect optometrists to pay out of pocket for the services that they provide. We are willing to look at their overhead costs, but we can’t just write a blank cheque.”

The optometrists say that $39-million amounts to just over $1 for each optometry service performed in that retroactive period.

Ontario Association of Optometrists president Dr. Sheldon Salaba elaborated. “Optometrists are the front-line workers of the vision-care system, and their services are at the heart of preventative screening for vision health in Ontario. With statistics showing that one-in-three Ontarians will encounter risk of vision loss by age 65, the government must work with optometrists to find a sustainable solution. The modernization plan includes properly supporting and expanding public coverage for routine eye exams; a crucial step in early detection of eye complications, avoiding irreversible vision loss."

For months, the Ontario Association of Optometrists pursued this government with concerns about the integrity of Ontario’s eye-care system with two requests: a formal negotiation process with a dispute resolution mechanism, and a commitment to an outcome that no longer requires optometrists to subsidize OHIP services. Since Sept. 1, 2021, OHIP patients have been unable to access OHIP-insured services.

After nearly eight months of radio silence from Ontario’s government, a two-day frenzy mediation took place. This was followed by a surprising public offer by the government which resulted in a one-time, $39-million retroactive payment directly to optometrists. This payment averages to just over $1 for each optometry service performed in the retroactive period. This payment was not negotiated with the Ontario Association of Optometrists, and the announcement came as negotiations for a new compensation agreement were reaching a standstill.

Further, the health ministry made the announcement with no notice to the association, delivered it directly to optometrists across Ontario, and widely publicized it in the media. More than 2,200 optometrists have since written to Elliott to say they do not offer their consent to receive this payment.

“It is neither fair nor reasonable to ignore the systemic nature of the funding problem by offering a one-time payment that does nothing to support care delivery in the future,” Salaba wrote in a statement. "We are fighting not just for our survival, but for a long-term solution that protects patients and public health. We ask the government to come to the table with a commitment to succeed where previous governments failed. Either cover the true cost of eye exams or give optometrists more flexibility in our billings. Optometrists are ready to adapt to ensure Ontarians get the accessible and quality eye care they deserve."

I have learned the following facts:
 

• In 1989, the Ontario government paid $39.15 to an optometrist for a single eye exam. Since then, that figure has increased on average 17 cents a year.
• Ontario optometrists provide more than four-million OHIP-insured eye exams a year, making up over 70 per cent of the patients at an average practice.
• Ontario laws make it illegal for optometrists to accept direct payment or alternate health insurance from OHIP-insured patients.
• Ontario physicians are the second-highest paid physicians in all of Canada; meanwhile, Ontario optometrists receive the lowest compensation rates across the country.
• An independent study commissioned by the Ontario Association of Optometrists found the average cost to provide an eye exam in Ontario was $75.51 in 2019.

OHIP pays for eye exams for people under age 19 and older than age 65, currently about $45 per exam. That’s barely $5 more than the fee in 1989 and only covers about 55 per cent of the true cost of about $80 per exam. In the “Dear Doctor” letter that Elliott tweeted on Aug. 23, the province offered to increase that by 8.5 per cent, but that would still leave optometrists grossly under-funded.

We have just lived through two years of COVID-19 and have experienced the under-payment to front-line health workers, PSWs and so forth.

Remotely connected, yet germane, is the fact that I enjoyed my career in education and received no pay increase during my final 10 years. Seems educators were considered over-paid while teachers left money on the table in order to decrease class sizes. It still sits in my craw after 20 years of retirement.

It seems challenging government decisions is very hard/bordering on impossible to gain enough public angst to rile citizens enough to demand better. I, for one, would rather have accessible eye care costs before a new superhighway 413.

The research I have shared has been sent to CARP, BOOMERS and other associations that are working hard to make sure that the interests of seniors are never ignored, or sidelined.

After reading this, I encourage you to take this as far as you wish with people who govern your future.

“Knowledge is power. Do with it as you wish at your own peril.” -- DW

‘Till next time!