Outreach Eye Services in Australia

1. Angus Turner¹
2. William Mullholland²
3. Hugh R. Taylor³

¹Lions Eye Institute, Perth, Australia
²McKinsey and Company
³University of Melbourne, Melbourne, Australia

PURPOSE:To identify key drivers of performance and describe funding models for outreach eye health services.

METHODS: A cross-sectional survey of nine outreach eye health services was performed. Semi-structured interviews were conducted with a range of stake-holders to identify the nature of services including workforce availability, funding levels and models, population characteristics and clinical activity levels. Multivariate analysis was performed to identify effects of key drivers including service integration, funding models. A cost-benefit analysis was performed to compare regions.

RESULTS: Service integration between optometry and ophthalmology resulted in an increased surgical case rate for ophthalmology clinics (R2=0.57). There were trends towards increased clinical activity and reduced waiting times. The supply of ophthalmologists (full time equivalence) to all remote regions was below the national average (up to nineteen times lower). Cataract surgery rates were also below national averages (up to ten times lower). Fee-for-service funding significantly increased clinical activity. There were also trends to shorter waiting times and lower costs per attendance.

CONCLUSIONS: Coordination of eye services may improve efficiency of services for patients. For outreach ophthalmology services, the funding model used for clinician reimbursement may influence the efficiency and costs of the services. Fee-for-service funding models, Safety-net funding options or differential funding/incentives need further exploration to ensure isolated disadvantaged areas prone to poor patient attendance are not neglected. In order for outreach eye health services to be sustainable, remuneration rates need to be comparable to those for urban practice.