General ophthalmic services

General ophthalmic services include eye tests, services provided by ophthalmic medical practitioners and corrective vision aids such as spectacles. Expenditure on general ophthalmic services was estimated via an analysis of primary care claims and payments in the ROI. The Primary Care Reimbursement Service (PCRS), part of the ROI Health Service Executive (HSE) Finance Directorate, has a national role in making payments to Primary Care Contractors for services provided by them under the Community Drug Schemes. Almost all payments in the community provided by optometrists and ophthalmologists are made by the PCRS.

The latest available PCRS claims and payments data is for the year 2008 (HSE, 2008). In 2008, payments to optometrists and ophthalmologists totalled €20,997,766. The volume of treatments in 2008 included 225,403 eye examinations and 304,879 appliances.

Table 3.6 presents the 2008 scale of fees for eye examinations payable under the HSE Community Ophthalmic Services Scheme.

Table 3.6: Eye examination scale of fees (HSE Community Ophthalmic Services Scheme)

Source: As presented by HSE (2008)

In the absence of more detailed data, the unweighted average eye examination fees (€44.11) was multiplied by the number of eye examinations in 2008 (225,403) to approximate the total expenditure on all eye examinations in 2008 (€9,942,076). This comprises 47% of total payments to optometrists and ophthalmologists in 2008 (€20,997,766).

There was no breakdown of eye tests by condition available for the ROI. As such, using the approach in the UK cost-of-illness study (Access Economics, 2009), a distribution was inferred from Scottish data published by the Information Services Division for the year ending 31 March 2010 (ISD, 2010). These data recorded General Ophthalmic service activity in Scotland, including the numbers of eye tests carried out by the National Health Service. Patient details including eye conditions were recorded by the opticians undertaking the eye tests.

The distribution of eye tests by eye condition is presented in Table 3.7 using the Scottish data. This distribution was applied to expenditure on eye tests in the ROI. These eye conditions are associated with VI and eye examination costs for those patients were included in the cost of illness calculations. It was conservatively assumed that all eye tests for ‘none of the above’ were conducted in people who were not vision impaired. The ‘none of the above’ category was therefore excluded from the calculation of total expenditure on VI.

Table 3.7: Eye tests in Scotland 2010 – distribution by eye condition

Source: ISD (2010). AMD includes the categories ‘AMD’ and ‘macula problems’

Expenditure on appliances in 2008 was estimated by deducting estimated expenditure on all eye tests in 2008 (€9,942,076 including those for people who are not VI) from total payments to ophthalmologists and optometrists in 2008 (€20,997,766). All estimated expenditure on appliances (€11,055,690 in 2008) was assumed to be for correction of refractive error and was thus allocated to the ‘other eye condition’ category.

Total expenditure on ophthalmic services for VI people in 2010, 2015 and 2020 was estimated by applying the estimated ROI population growth (CSO, 2008) from 2008 to total expenditure in 2008.

Estimates of total expenditure on general ophthalmic services are presented by condition in Table 3.8. Total expenditure on general ophthalmic services for VI people in 2010 was estimated to be nearly €15.1 million, and is projected to increase to €18.5 million by 2020.

Table 3.8: Estimated total expenditure on general ophthalmic services

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