5 things to know about the optometry funding issue, and how the government can fix it
MPP Robin Martin, Parliamentary Assistant to the Minister of Health Christine Elliott, appeared recently on The Agenda with Steve Paikan, along with OAO president Sheldon Salaba, to discuss the current optometry situation.
Here’s the full clip of the discussion:
The first step to fixing this issue is not nearly as complicated as MPP Martin is making it out to be.
Job action could end today with a simple commitment from the Ministry of Health, which they have been reluctant to make.
Here is a quick hit summary of what the main issues are:
1. Optometry is underfunded in Ontario, with almost no increases to reimbursement in 30 years
This part is not in dispute.
The amount that the Ontario government reimburses an optometry office for providing an eye exam to eligible patients has only gone up by about $5 in 30+ years.
Anyone can agree this is ridiculous.
2. Ontario has the lowest funded eye exam in Canada
Not all provinces provide funding for eye care, but for those that do, Ontario is far below any other province. The next lowest is Manitoba at $77.
In this clip below, Robin Martin tries to defend that comparison by talking about frequency of covered exams:
Optometrists in Manitoba providing those eye exams every two years will have their basic operating costs covered by the $77 their office receives.
In Ontario, the patient will be eligible more frequently, where optometrists will be paying to see those patients (that are “covered” by their health card), and doing it twice as often. The Ontario government may be paying more money out in total, but at unreasonable rates per occurrence.
Every instance of providing care below cost continues to push the system further away from sustainability.
3. Inflation alone should have raised reimbursement significantly, but it hasn’t
It’s an easy exercise to enter the OHIP billing fees from 1989 into an inflation calculator and see what the equivalent amount would be today:
~ $39 in 1989 = ~ $74 in 2021 … an 89% increase
When the average reimbursement instead rests $30 lower than that today, you can see why there’s an issue.
Watch this great video above that illustrates the inflation issue quite well.
4. The Ministry wants to dispute costs, but has done no work on their own to determine what those costs are
Late last year the OAO invited the government to participate in the chair-time cost study that would help inform the negotiations, but the government did not take part.
“We don’t know what it costs. We can’t just take their word for it.”
This is what Robin Martin said in the recent TVO interview, but the government has had plenty of opportunity to be involved in determining those costs, they have just chosen not to get involved.
If they truly have no idea what it costs to provide care, how could the Ministry defend the current reimbursement rates for so long?
Even before an in-depth cost analysis is done, a comparison to other provinces along with a look at inflation rates alone can easily show how big the gap may be.
5. The government has yet to commit to covering the cost to provide care
This is the big one.
Even if the government wants to try and delay the process of determining a new concrete funding agreement, the core of what Ontario optometrists are looking for is to ensure that regardless of how it’s done, we need to have a system that allows us to cover our operating costs to provide care.
The government may want to talk about a “constrained fiscal environment” that prevents them from paying fair compensation for services rendered, but there are ways to ensure operating costs are covered without large increases to government spending.
It’s clear there is plenty to talk about at a negotiating table, but the reasonable ask being made by optometrists is that regardless of how it’s done, we need a commitment from the government that we will end up with a system that allows for, at minimum, cost recovery, and to bring Ontario in line with the rest of Canada.
Without this simple foundation, meaningful progress can not be made.
This clip really summarizes the situation best:
It doesn’t make sense to have a system where you provide care for less than cost.
At the end of the day, this is about maintaining access to care.
Optometrists want to provide high level care to all of their patients, regardless of age, but that’s not possible without being reimbursed by the government at least at a level that prevents them from being the ones paying to see those patients who are said to be covered for their exams.
If the government is ready to formally agree to this simple premise, and work towards a sustainable system, optometrists are all ears.