Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme

8.6 Estimates of the Scheme’s impact

Page last updated: 28 February 2012

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.
Optometry services supported by MBS per 1,000 persons by age group and remoteness area, 2000-01 to 2009-10
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.
VOS has a material impact in reducing these gaps. Its impact is greatest for populations in very remote areas, where VOS improves access by approximately 30%.
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:
Remoteness Area: 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Optometry services for which on MBS payment was made '000
Major Cities 2781 2903 3020 3136 3288 3501 3607 3755 3924 4240 4433
Inner Regional 832 858 892 927 975 1050 1081 1122 1156 1250 1305
Outer Regional 392 405 416 428 441 473 483 504 518 550 569
Remote 53 55 57 57 58 61 61 64 64 67 68
Very Remote 21 21 23 23 23 24 25 26 27 29 30
Australia 4079 4242 4407 4571 4784 5108 5257 5471 5689 6135 6406
 
Optometry services per 100 persons (not aged adjusted)
Major Cities 209 218 227 232 240 252 257 263 269 284 292
Inner Regional 217 224 233 239 248 264 267 272 275 292 299
Outer Regional 207 214 219 225 230 245 247 255 258 269 274
Remote 170 175 180 182 183 194 194 202 202 207 210
Very Remote 122 125 134 138 137 141 149 155 156 166 172
Australia 209 217 226 231 239 252 256 262 267 282 289
                       
Estimated optometry services per 1000 persons age adjusted
Major Cities 212 221 230 235 244 256 260 266 273 288 296
Inner Regional 208 215 223 229 238 253 256 261 264 280 287
Outer Regional 202 208 214 219 224 239 241 248 251 262 267
Remote 177 183 188 190 192 202 203 211 211 216 220
Very Remote 139 143 153 158 157 162 170 178 179 190 197
Australia 209 217 226 231 239 252 256 262 267 282 289
 
Specialist services per 1,000 relative to major cities (Major cities = 100)
Major Cities 100 100 100 100 100 100 100 100 100 100 100
Inner Regional 98 97 97 97 98 99 98 98 97 97 97
Outer Regional 95 94 93 93 92 93 93 93 92 91 90
Remote 84 83 82 81 79 79 78 79 77 75 74
Very Remote 66 65 67 67 65 63 66 67 66 66 67
Australia 99 98 98 98 98 98 98 98 98 98 98


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
Major Cities - - - 295.7 295.7 0.0% 0.0%
Inner Regional 0.4 0.0 0.5 286.2 286.7 0.2% 0.2%
Outer Regional 3.9 0.4 4.3 263.0 267.3 1.6% 1.5%
Remote 11.7 1.9 13.5 206.3 219.8 6.2% 4.6%
Very Remote 29.9 10.0 39.9 157.0 197.0 20.3% 13.5%
Australia 0.9 0.2 1.0 288.3 289.3 0.3% 0.3%



VOS supported services and estimated total optometry services per  1,000 population
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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