Ontario Optometrists are reimbursed at the lowest rate in Canada … and it’s not even close
The Ford government and the Ontario Association of Optometrists are in a standoff right now, and a big reason is that both sides have much different opinions on what they consider to be “fair and reasonable.”
As a quick primer, here’s the eye care services that are covered by OHIP, as seen here in this Ministry fact sheet:
Kids, seniors, and some adults are typically “covered” by OHIP for their exams.
I use the quotes, though, because the amount that the government reimburses an optometry office is not even close to the cost needed to provide that service.
Those OHIP fees have also only increased by a few dollars in over 30 years. This is not a sustainable system.
The provincial government has offered what they believe to be a fair solution going forward to solve 30+ years of chronic under funding: a 8.48% increase to fee codes.
With today’s fee structure, if a senior comes in for an emergency appointment (say for a retinal detachment, or sudden onset wet macular degeneration), the government will pay the optometry office a total of $25.15 for that visit (yes, it’s that low).
Also, it’s illegal for the optometrist to charge anything above that fee for the actual exam, since that patient is being covered by their health card.
As you can imagine, the operating costs to provide care (equipment, rent, staff costs, etc) are a little more than 25 dollars.
A 8.48% increase to that fee code will bring it up to a tidy $27.28.
That ought to fix things, right?
Yeah, not so much. There is a systemic flaw to how optometry funding is handled in Ontario, and a few extra dollars per exam is not going to bridge that gap.
The worst in the country
Optometrists in Ontario have known for quite some time that the government funding here for exams was bad, and the public is now becoming much more aware of this fact too.
I think what surprised optometrists most, though, is just how bad it is when you start looking at other provinces. That’s where I want to focus the attention today, to help paint a picture of how far behind Ontario is compared to the rest of Canada.
Funding models
There are 3 main ways to approach optometry funding, and each province can chose to go about it slightly differently:
- No government funding for eye care — The costs are paid completely by the patient, regardless of their age (used in places like Saskatchewan or some of the Atlantic provinces, with exceptions for certain populations)
- Partial government funding (“Balance billing”) — A portion of the exam is paid by the province, and the patient is charged the rest (done in BC). They could then use private insurance they may have to cover the rest
- Total government funding (at least for some populations) — Patients who are covered can get an exam without paying anything out of pocket
We’re going to look specifically at the provinces that would be most equivalent to Ontario in terms of how they currently operate.
Quebec
For our neighbours, provincial optometric coverage recently went through its own set of changes in 2018.
They used to be paid at the levels currently seen in Ontario (in the $40 range for kids/seniors)… until optometrists took a stand.
“The AOQ contends that for 15 years the Health Department has turned a deaf ear to its demands for increases in fees it can charge for publicly insured procedures. The organization argues that operating costs for its members have increased by more than 150 per cent during the past 30 years, while increases in fees charged to patients and covered by RAMQ have increased by 56 per cent during the same period.”
Sounds similar to the current situation in Ontario, doesn’t it?
As a good friend once said to me: “Fighting back makes a difference.”
A deal was reached, and the provincial government now funds covered eye exams at a much more reasonable rate.
“Optometrists warned in February they would go private and leave the public health system, saying the amount they are reimbursed by RAMQ for covered exams was too little, leaving them to pay for some of the patient’s bill. Whatever is actually in the agreement-in-principle that got them to change their minds is unknown, all a representative for l’Association des optométristes du Québec would say is compromises were made by both sides but there would be no more exams done “at a loss.”
Must be nice.
Their billing structure doesn’t use a single fee, but instead has separate billing codes over top of the base amount for things like a slit lamp exam (the main health check with the biomicroscope), field screening with finger counting, etc. … and could add up to government funding of over $100 for a senior eye exam.
The exact same level of care in Ontario is funded at $47.00 by our provincial government
Manitoba
Making our way out west, the population eligible for coverage is much the same as Ontario:
“Manitoba Health insures basic optometric eye exams for children ages 0–18 years and seniors aged 65 years and over every 2 calendar years, starting with odd years. Ocular health exams for Manitobans of any age with diagnosed eye disease or those defined as high risk for developing eye disease (ex. If you have diabetes) are also insured.”
They also implement a separate billing code system for the base exam, then additional covered fees for standard tests likely to be used all the time (measuring eye pressure, using dilating drops, etc).
So if a senior is seen in Winnipeg, and their eye exam includes a pressure measurement and a dilation, the optometry office can bill the government $77. 18 for those services.
Alberta
In what looks to be the best funded eye care system, the government covers the same types of populations (kids, seniors, some adults), but pay out a much better base amount ($80.70), as well as separate coverage for the dilated exam portion (when applicable).
So a senior with diabetes in Calgary could go for a complete eye exam with pupil dilation, not pay a dime out of pocket, and the optometrist office is able to be reimbursed $137.02 from the government for providing that care.
In Ontario it’s $47.00.
They also have emergency coverage that makes a lot more sense than what is currently used in Ontario
Not only are they better funded, their system is more functional.
Something has to change
It’s not hard to see that the situation in Ontario is bad.
Optometric care had been undervalued here for decades, and optometrists across the province have decided to step up.
We want to be able to provide the level of care that our patients deserve, and maintain equal access to that care regardless of age or circumstance … but at the current funding system used in Ontario, it’s just not possible anymore.
You can’t have a sustainable system if optometrists are working at a loss every time they see an OHIP-insured patient. It doesn’t work.
2 important points are clear:
- Exams are reimbursed for less than cost in Ontario
- That fee is far below the equivalent of any other province
A fee increase from the government to cover basic costs, while also bringing Ontario to equal footing as the rest of Canada … that sounds fair and reasonable to us.
If you agree, please call your MPP and let them know that access to optometric eye care is important to you.
When the government hears directly from the people they serve, change is possible.
It’s time to save eye care in Ontario.
