Randall Denley: Can eye care in Ontario get worse? I don’t see how

ByMartha R. Camara

Sep 9, 2021

Ontario is doing a remarkably poor job of funding the limited eye care it provides

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Eye care in Ontario is a mess. Doug Ford’s government did not create the problem, but it will have to fix it.

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The province’s optometrists are demanding higher wages and have withdrawn OHIP-covered services for seniors and children. In the world of Canadian Medicare, patients cannot directly pay for the service because it is covered by OHIP, even when it is not provided by OHIP.

In addition, eye surgery performed by ophthalmologists is greatly slowed down due to the pandemic. The backlog, mostly for cataracts, represents more than a third of Ontario’s total surgery queue, according to the province’s financial accountability officer. This is a problem that will take years to solve.

Eye doctors also say they are underpaid, receiving just under $400 from the government for cataract surgery that previously paid them $535. Ontario’s rate is the lowest in Canada, according to Ontario eye doctors and surgeons.

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Eye care is a microcosm of what is wrong with Canada’s approach to medicare, and it starts with the Canada Health Act, the founding document of medicare. The Health Act does not mandate eye care except in an emergency. Presumably, federal politicians don’t believe the eye is an important part of the human body. Therefore, some provinces do not cover eye care. Most, like Ontario, provide coverage for seniors or children.

Ontario is doing remarkably poorly in funding the limited eye care it provides. The dispute with optometrists is a good example. Optometrists are not doctors, but are trained eye specialists who perform eye exams, prescribe eyeglasses and monitor care. Ontario optometrists receive about $45 for an eye exam, a figure that has changed little in 30 years. The Ontario Association of Optometrists says the exam costs them about $80, so they lose money with each service. That’s a big deal when OHIP-covered eye exams make up about 70% of your business.

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To put Ontario’s fees into context, the next lowest fee comes in Manitoba, which pays $77 for an exam. Ontario optometrists say they would be happy with that number.

So far, Ontario has proposed raising its fees to $49 and is offering a retroactive payment of $39 million, or about $16,000 each for the province’s 2,500 optometrists. Optometrists say that’s not enough, and they’re right, as odious as their withdrawal from child and elder care is.

Compared to other cost pressures in the healthcare system, fixing the optometrist’s situation is not too costly. Optometrists provide approximately four million exams per year. Fulfilling their request would cost around $140 million.

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Ophthalmologists are an entirely different matter. For starters, there aren’t enough. The number of ophthalmologists has not kept pace with population growth over the past decade, let alone the growing demand of an aging population. Ophthalmologists say the volume of work they do has increased by 36% since 2005, but the workforce has only increased by 5%. This is somewhat offset by modern technology which allows them to do many more procedures in a day.

The higher volume and limited supply of physicians has significantly increased the earnings of ophthalmologists. Between 2011 and 2018, nine of the province’s 20 highest-billed physicians were ophthalmologists.

Ophthalmologists certainly do not suffer as much as their patients. For elderly people awaiting cataract surgery, the ophthalmological situation is more than an inconvenience. Cataracts can significantly reduce vision, affecting seniors’ quality of life, driving ability and independence.

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The provincial government is trying to reduce the backlog of cataract surgeries by taking the unusual step of contracting private eye clinics to perform the surgeries at OHIP rates, which they theoretically already do. Private clinics offer services that go beyond basic OHIP cataract services, but the provincial government says no fees can be charged for “medically necessary” cataract surgery. Either way, people willing to pay between $3,000 and $5,000 per eye for extras can get their eyes fixed much faster than those in the OHIP queue.

The government says some have agreed to do this, but human nature suggests that getting 10 times the amount by charging directly will limit the enthusiasm of eye doctors.

It’s hard to see how eye care in Ontario can get worse. Older people can’t even get their eyeglass prescriptions updated, and many are waiting for cataract surgery in the distant future. Their alternative is to spend an expensive amount of money to get this service covered by the government sooner. Surely Ontario can do better.

Randall Denley is an Ottawa political commentator, author and former Ontario Conservative candidate. Contact him at [email protected]

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