The aim of VOS is to “to improve the access for people living and working in remote and very remote communities to optometric services” (DoHA 2011e, p. 4). Its objectives are to:
- Improve the eye health of Australians living and working in remote and very remote areas, and rural communities with an identified need for optometric services.
- Increase visiting optometrist services in areas of identified need.
- Support optometrists to provide outreach services.
- Encourage and facilitate integration and communication between visiting optometrists, local health providers and other visiting health professionals about ongoing patient care.
VOS commenced in 1975 and is enabled under section 129A of the Health Insurance Act 1973. This section provides that “the Minister may on behalf of the Commonwealth make such special arrangements with VOS optometrists as he or she thinks fit for the purpose of ensuring that an adequate optometry service will be available to persons living in isolated areas”. VOS optometrists are those eligible to provide services for which medical benefits can be paid under Medicare. Under Medicare, optometrists give a ‘common form of undertaking’, which is accepted by the Minister for Health, related to the arrangements under which services are to be provided and benefits paid.
An interpretation of the current legislation is that VOS must be administered by DoHA, although there seems to be no specific requirement under section 129A that this is the case. Currently the Minister for Health and Ageing delegates powers under Section 129A to the National Manager, Regional Health Australia, Primary and Ambulatory Care Division. All funding agreements with VOS optometrists are approved by this delegate.
VOS has operated continuously since 1975 under a range of changes to national health policy settings, including the dismantling of the original Medibank, and the introduction of Medicare. Arising out of the Taylor review of Indigenous eye health (Taylor 1997) additional funding agreements were developed with organisations targeting optometry services for Aboriginal and Torres Strait Islander people, for example, through ICEE.
A review of VOS was undertaken in 2005-06. As a result, a number of changes were made to the program announced in the 2006-07 budget (DoHA 2007). These included the streamlining of some aspects of its administration. Under the prior arrangements, VOS optometrists were required to provide details of expenses (such as receipts) incurred whilst providing outreach services. The new arrangements simplified the processes for approving budgets and submitting invoices following outreach visits. The changes at this time also amended the definition of persons living in isolated areas to reflect the ARIA remoteness classification. A grandfather arrangement was made in relation to approved services that fell outside remote and very remote areas under the new definitions. These services were offered a two year agreement. From July 2009 the definition of persons living in isolated areas changed again, this time to reflect the ASGC Remoteness Area (DoHA 2009b).
In addition to the original VOS scheme (Core VOS), the Australian Government announced funding during 2009-10 for the VOS Expansion for Indigenous Australians (VOS IA). This was funded under the Improving Eye and Ear Health Services for Indigenous Australians for Better Education and Employment Outcomes measure. The Indigenous expansion targets remote and very remote Indigenous communities (RA 4 and RA 5). According to the Program Guidelines for the Visiting Optometrist Scheme (DoHA 2011e) VOS IA “is not intended to take services for Indigenous Australians away from the Core VOS element, but provide for new and increased services. Services provided to areas with both Indigenous and non-Indigenous people should continue to apply for Core VOS” (DoHA 2011e, p. 6).