To estimate the impact of VOS on access to optometry services, an analysis was undertaken of services supported through medical benefits under Medicare and the number of patients supported under VOS. As discussed previously, in 2010-11 there were 6.7 million optometry services for which a medical benefits claim was lodged and $316 million in benefits paid. Assuming there is one Medicare claim for every patient seen under VOS, services supported represent around 0.34% of total optometry services supported under Medicare. An average of 1.2 claims per patient implied VOS represents around 0.40% of total optometry services supported under Medicare.
Data has been provided by DoHA giving the number of services for which a medical benefit for optometry was paid for the years 1999-2000 to 2009-10. Services were also grouped into the remoteness area of the Medicare beneficiary, jurisdiction and the sex and age group of the beneficiary.
Figure 20 provides an analysis of the level of optometry services in the 2006-07 financial year by age group and remoteness area . There are several notable features that emerge from this analysis. Overall use of optometry increases by age up to the 75-79 age group. However, when comparing rates for remoteness areas services rates are higher in major cities compared with other remoteness areas for age groups up to the 55-59 years age group. For older age groups a more complex situation emerges. For most of the older age groups (60 years and above) higher rates of use tend to be highest in inner and outer regional areas. For some of the older age groups, rates are also higher for remote and very remote areas.
When age adjusted, services tend to be higher in major cities (a rate ratio of 1.02) compared with inner regional (rate ratio 1.00), outer regional (rate ratio of 0.95), remote (rate ratio of 0.81) and very remote (rate ratio of 0.69). An interesting finding is that the gap between major cities and rural and remote areas is principally due to lower levels of service for younger age groups. For older age groups, access to optometry tends to be lower in major cities. One factor that may impact this is higher use of ophthalmology services in major cities for older people.
Figure 20 – Optometry services supported by MBS per 1,000 persons by age group and remoteness area, 2000-01 to 2009-10
Table 48 shows the number of optometry services for which an MBS benefit was paid by the AGSC remoteness areas for the period 1999-2000 to 2009-10. Estimated services per 1,000 population without age adjustment are shown along with an estimate of age adjusted services per 1,000 population See previous footnote.. Overall there were an estimated 289 services per 1,000 population provided during 2009-10. Using the rates of services per 1,000 persons in major cities as the reference point, access to optometry services are 97% of the major city rate for inner regional areas, 90% of the major city rate in outer regional areas, 74% in remote and 67% in very remote.
Over the period analysed, the gap between major cities, inner regional and very remote areas has remained similar. However, the gap has widened for outer regional (from around 95% to 90%) and remote areas (from 84% to 74%).
Table 83 and Figure 21 present the basis for estimating the impact of VOS in terms of access to optometry services. Overall, VOS services (using the data for 2010-11) represents a level of provision ranging from 0.5 services per 1,000 people in inner regional areas, 4.3 in outer regional, 13.5 in remote and 39.9 in very remote areas. Relative to the underlying rate in each remoteness area, it is estimated that VOS supported services increase the level of provision by 0.2% in inner regional areas, 1.6% in outer regional, 6.2% in remote and 20.3% in very remote areas. Relative to the level of service provision in major cities, VOS supported services increase the level of provision by 0.2% in inner regional areas, 1.5% in outer regional, 4.6% in remote and 13.5% in very remote areas.
The overall conclusions to be drawn from this analysis are:
- There are gaps in access to optometry services for rural and remote populations.
- These gaps are not as large as observed for specialist services.
- The gaps are most significant for outer regional, remote and very remote areas.
- The gaps in access appear to be principally related to access for optometry services for age groups under 60 years of age.
Table 82 Optometry services supported by MBS per 1,000 persons by remoteness area, 2000-01 to 2009-10Top of page
|Financial year ended 30 June:|
|Optometry services for which on MBS payment was made '000|
|Optometry services per 100 persons (not aged adjusted)|
|Estimated optometry services per 1000 persons age adjusted|
|Specialist services per 1,000 relative to major cities (Major cities = 100)|
Source: Health Policy Analysis of Medicare Data Extract
Table 83 Optometry services for which an MBS payment was made and VOS services per 1,000 population by remoteness areas, 1999-2000 to 2009-10
|VOS Core||VOS IA||VOS Total||Medicare Excluding VOS||Total Medicare||VOS impact relative to:|
|RA Rate||Major Cities rate|
Figure 21 – VOS supported services and estimated total optometry services per 1,000 population age adjusted by remoteness areas, 2010-11
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