Meet Dr Damien Smith, the former principal advocate for the Optometrists Association Australia.

Dr Damien Smith was the principal advocate for the Optometrists Association Australia in the negotiations that led to the introduction of Medicare benefits for clinical services by optometrists. He was also a member of all the joint profession-department working parties that designed the administrative detail of the new arrangements. He was president of the World Council of Optometry between 2002 and 2004. 

Damien saw firsthand the impact that changes to the funding of eye-care, initiated by Medibank in 1975 and then reinforced by Medicare in 1984, had in changing the eye-care landscape in Australia. 

The pre-Medicare arrangements provided a financial incentive for healthy patients without eye disease to attend ophthalmologists (medical eye-specialists) located in the CBD of capital cities and a handful of large regional towns. 

This burdened a health service designed to treat unwell and diseased persons, and because of limited access, discriminated against lower income groups and rural communities. The arrangements were inefficient, inequitable, costly and unfit for purpose. 

Medicare introduced a Medicare rebate for consultations with optometrists, who were at that time distributed across capital cities, metropolitan suburbs and country towns. This right of free choice of eye-care practitioner, either optometrist or ophthalmologist, without financial penalty, improved the accessibility and affordability of eye-care for all Australians, especially disadvantaged and remote communities.   

Affordability remains because around 95% of rebateable services by optometrists are bulk-billed meaning that patients face no gap payment. 

The introduction of Medicare has also been a win-win for the professions. Optometrist training has lengthened and diversified so that optometrists now treat minor eye disease and prescribe spectacles. Ophthalmologists, freed from the burden of caring for healthy eyes, have also strengthened their training programmes so that today’s ophthalmologists have refined surgical skills and rank among the world’s best. 

Most of all, it has been ordinary Australians who have benefitted most from Medicare’s transformation of how eye-care is delivered and funded. Eye-care in Australia is accessible, affordable, high quality yet cost-efficient. It is arguably the best eye-care service in the world. 

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