Ontario’s optometrists hope the provincial government has the vision to increase their pay for seeing patients covered by the Ontario Health Insurance Plan (OHIP). Meanwhile, some patients are seeing red because they cannot make an appointment with their optometrist.
Since September 1, optometrists across Ontario have been refusing to see children and senior citizens whose eye examinations are paid for by OHIP in protest of the lack of increase in what OHIP pays each optometrist per examination. An optometrist in Ontario may bill no more than $47 per senior citizen’s eye examination, which is the lowest amount in Canada. The Province of Alberta’s amount is the highest in Canada – the government there pays optometrists $137 per senior’s examination.
The amounts Ontario optometrists may bill for children’s eye examinations – or for people receiving eye care through the Ontario Disability Support Program, or Ontario Works – varies. According to the Ontario Association of Optometrists (OAO), the average amount an optometrist in Ontario receives in return for publicly insured services is $44.65 per eye examination. In 1989, the amount was $39.15. In nearby Québec, the provincial government pays optometrists $107 per senior’s eye examination.
“Optometry isn’t the same as 30 years ago,” said Hawkesbury optometrist, Dr. Morris Hazan.
The local optometrist said technologies and techniques have advanced, which means the cost of providing modern services to patients has also increased. Hazan said he has always had a keen interest in ensuring the elderly receive the best eye care available.
“It comes down to what the government funds for services,” said Dr. Joshua Smith, an optometrist in Alexandria, who served as OAO President from 2018 to 2020.
Smith said the average cost of an eye examination in Ontario is closer to $80 these days and added optometrists also have expenses from operating their practices and paying employees. Smith said the average of $80 was found in a study by BDO which confidentially reviewed the financial statements of 75 optometry practices representing 300 optometrists across Ontario.
According to Smith, 80 to 90 per cent of optometry patients covered by OHIP are in rural areas and small towns.
Smith and Hazan said other provinces allow optometrists to bill variably, depending on the nature of the patient’s situation. Glaucoma patients often require numerous appointments per year, but OHIP does not differentiate the billing between patients with glaucoma and those who require glasses.
Hazan said he does not want to end up restricting the number of senior patients he sees.
“That’s not health care.”
Smith said Ontario’s health budget is approximately $70 billion and eye care is 0.2 per cent of that budget. He said if the government increased funding to cover the $80 average, it would still only be 0.4 per cent of the health budget.
“What we’re asking for is rooted in evidence,” he said.
Patients normally covered by OHIP for optometry services in Ontario are not permitted to go to an optometrist and pay for an appointment that would normally be covered by the provincial insurance system. Most patients are instead being directed to see their regular physician, go to hospital emergency departments, urgent care clinics, or to see ophthalmologists who have received referrals from optometrists.
Smith and Hazan believe public support is on the side of the optometrists, but not all patients are pleased they cannot make appointments.
“I have my visits covered by OHIP and during my last visit, my prescription had changed so much I was dangerously close to having my driver’s license removed on site,” said Natalie Amell. “I called back in September for my overdue appointment, and they can’t see me until November due to this situation.”
A woman who did not want to be named shared the experience of her 88-year-old father.
“They explained that they couldn’t see him because of their protest. He waited 7 hours in emergency to be told he had a scratched cornea. They prescribed drops to heal it and wanted him to go back the next day for a follow up. He waited 5 hours the next day.”
Other patients who contacted The Review to share their stories said they are unable to get appointments for their children with special needs, or are having vision difficulties which are impairing their ability to do their jobs safely. Three patients told The Review they offered to pay for their appointments, but were denied due to OHIP regulations.
Meanwhile, optometrists across Ontario are continuing their job action. The OAO has launched a large-scale public relations campaign asking citizens to contact MPP’s, the Minister of Health, and Premier Doug Ford to ask for increases to OHIP eye care funding.