Dear Editor:
On Sept 1st, Ontario optometrists were forced to make the difficult decision that they could no longer provide care for their OHIP insured patients given the governments neglect of eye care for the past 32 years. Since provincial law prohibits payment for an eye examination outside of OHIP, Ontarians with OHIP can no longer obtain a timely eye exam.
This decision did not come easily nor quickly. For over 30 years, successive Ontario governments have ignored optometrists. In 1989, the fee for an OHIP insured eye exam was $39.15; today, over 32 years later, it is on average $44.65. This has not kept up with inflation of over 80% over that period and currently covers less than half the cost (including rent, staff, utilities, equipment, taxes, and supplies) to provide an eye exam. Every time an optometrist performs an OHIP insured eye exam it is at a loss. In 2019 alone, Ontario’s optometrists subsidized the delivery of OHIP-covered eye care by $173M. This is not sustainable.
Optometry’s asks are simple ones, fair and long overdue.
1) We require some method that permits optometry to at least recover the costs of providing an eye exam. Numerous models have been proposed in the past and are used in other jurisdictions. We would accept any model that allows us to recover our cost for these services. Nine other provinces have adopted such changes over the past 25 years.
2) Like medicine, nursing and teaching, we need a mandatory mechanism for negotiation. Optometry has no mechanism which commits the government to negotiate. Numerous funding models to permit the ongoing care in the past have been suggested. Optometry’s white paper showed where efficiencies and saving could be utilized in Ontario’s eyecare system. Many meetings and committees to look at eyecare needs were promised by the province over 3 decades but never materialized. The ministry has received studies in 2012 and 2021 again showing cost to provide eye care but no discussions occurred. The Ministry of Health was told in June 2020 that status quo was no longer an option as other sources of income could no longer support the increasing numbers of OHIP insured patients seeking care for eye disease in our offices. In March, we advised the ministry, that care could not continue in the fall. All of this was ignored and no correspondence from the government was received from Dec 2020 until early August 2021, when the ministry finally responded to a request to meet with optometry.
Health Minister Elliott’s offer at that meeting only served to demonstrate that the government continues to turn a blind eye to the future of eyecare in this province. The province’s offer of a one-time payment of $39 million for the past 10 years to “catch up” (despite 32 years of neglect) has never been a request of our association. We are trying to find a sustainable solution for the future. Optometrists have already found ways to keep our offices open in the past 3 decades as we subsidized OHIP from other sources of revenue. Ontario optometrists perform over 4 million OHIP issued services annually; close to 40 million exams in the past decade. This latest payment represents less than $1.00 for each of those examinations. Currently, our clinics subsidize OHIP examinations to the tune of $40 to $50 under COVID protocols (and $35 to $40/exam prior to COVID). 39 million hardly represents a “catch up” when we still subsidized each exam by $39.
The ministry also offered an 8.48% (approx. $3.79/exam) increase similar to what physicians had received in the past decade. COVID alone has increased operating costs by 15%. Covering half the cost appears to be Ministry of Health policy where optometry is concerned. An 8.48% seems neither fair nor sincere given inflation of 80% since 1989. Tying our increases to medicine might be fair if optometry was not stuck in 1990’s remuneration rates while medicine has had increases over the past 3 decades. The OMA enjoys the second highest remuneration rates in the country. Ontario optometrists by far receive the lowest fees for provincially funded eye care services; 60% lower than the next closest province, Manitoba. The provinces increase would move a senior’s eye examination to almost $51, still only two-thirds of Manitoba’s $77. Ontario optometrists would remain the poorest funded eyecare in Canada, with a schedule of benefits less than half of Alberta’s or Quebec’s who, along with Manitoba, are the only other provinces to fully fund eye care. Tying optometry’s future increases to medicine would mean our schedule of benefits would take decades to reach the $80 plus figure it currently costs to provide an eye exam. We would continue to subsidize publicly funded eyecare forever. The Health Minister has stated, “It is not your [optometrists’] responsibility to be paying out of your pockets for these services. It’s fairness to everyone that we want to achieve.” Yet, no one at the Ministry of Health would seem to have the math skills to see that their offer is neither fair nor permits for sustainable eyecare for the residents of Ontario
Minister Elliott has also stated they have entered rigorous negotiations with optometry and yet no meetings or correspondence from the government occurred for 9 months. They claim to be committed to a working group, but they will not commit to any binding mediation. All previous promises of working groups have either failed to materialize or their recommendations were ignored by government. The province remains content to fund part of optometric care and expect optometrist to fund the majority of eye exam services as they have done for decades.
Eyecare for OHIP patients has long been suffering especially for our seniors who require the most time and resources from our practices. We have long passed the days of just trying to be more efficient. Most practices, for years, have already been forced to reduce the number of OHIP patients they can see in a day, reduce the number of services per patient, or reduce their time per OHIP patient. Many practices have stopped taking new OHIP patients or stopped seeing OHIP patients all together. Some practices stopped seeing OHIP patients years ago. It is unfair that patients have to be denied care because their managed care insurance provider pays nothing close to covering the cost of providing these services. Our patients and Ontario residents deserve far better than that.
The province’s attempted bribe of $39 million and 8.48% offer only to maintain the status quo. Nothing has yet been offered by the province as a solution to secure future eyecare for OHIP insured seniors and children. Optometrists have now been forced to make a difficult decision. Either we continue to see all our patients and ultimately close our doors and eliminate care for all or see only some of our patients (those without OHIP coverage) so that we can continue to pay our bills, provide for our staff and their families and at least provide care to some of Ontario residents. Under current legislation and this OHIP Schedule of Benefits, providing eyecare services to OHIP patients remains unviable. For our patients currently struggling to get care, we apologize that government inaction has put you in this situation. All other options have been exhausted over the past 25 years without a response from the government. For patients concerned about their loss of care, we encourage them to visit saveeyecare.ca and call their MPP directly.
Sincerely,
The Optometrists of Grey Bruce
Dr. Greg Carr
Dr. Sandra Chiu
Dr. Sean D. Colquhoun
Dr. Joseph T. Dang
Dr. Heather Davidson
Dr. Madison Dors
Dr. Robert Dors
Dr. Jessica Fullerton
Dr. James Grundman
Dr. Nikki Huggins
Dr. Tasha Hotz
Dr. Andrea Jones
Dr. Michelle Lafleur
Dr. Heather MacKenzie
Dr. Maureen Oriahi
Dr. Maureen Oyaide-Ofenor
Dr. Bill Pym
Dr. Christina Pym
Dr. Kristen Robinson
Dr. Richard Samuell
Dr. Mary Shouldice
Dr. John Shute
Dr. Jade Sullivan
Dr. Robin Thiel
Dr. Andrea Traynor
Dr. Joseph Traynor
Dr. Bridget Valsamis
Dr. Heidi Wulff
