Funding models for outreach ophthalmology services.

BACKGROUND: This paper aims to describe funding models used and compare the effects of funding models for remuneration on clinical activity and cost-effectiveness in outreach eye services in Australia. DESIGN: Cross-sectional case study based in remote outreach ophthalmology services in Australia. PARTICIPANTS: Key stake-holders from eye services in nine outreach regions participated in the study. METHODS: Semistructured interviews were conducted to perform a qualitative assessment of outreach eye services' funding mechanisms. Records of clinical activity were used to statistically compare funding models. MAIN OUTCOME MEASURES: Workforce availability (supply of ophthalmologists), costs of services, clinical activity (surgery and clinic consultation rates) and waiting times. RESULTS: The supply of ophthalmologists (full-time equivalence) to all remote regions was below the national average (up to 19 times lower). Cataract surgery rates were also below national averages (up to 10 times lower). Fee-for-service funding significantly increased clinical activity. There were also trends to shorter waiting times and lower costs per attendance. CONCLUSIONS: 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.

Coordination of outreach eye services in remote Australia.

BACKGROUND: This paper aims to describe models for service integration between ophthalmology and optometry when conducting outreach eye services. The effect of good coordination on clinical activity and cost-effectiveness is examined. DESIGN: Cross-sectional case study based on remote outreach ophthalmology services in Australia. PARTICIPANTS: Key stake-holders from eye services in nine outreach regions participated in the study. METHODS: Semistructured interviews were conducted to perform a qualitative assessment of outreach eye services' levels of coordination. Records of clinical activity were used to statistically compare the effects of good coordination. MAIN OUTCOME MEASURES: Clinical activity (surgery and clinic consultation rates), waiting times and costs per attendance. Surgical case rate being the proportion of surgery that results from a clinic. RESULTS: Service integration between optometry and ophthalmology resulted in an increased surgical case rate for ophthalmology clinics (R(2) = 0.57). There were trends towards increased clinical activity and reduced waiting times, and costs/attendance were stable. CONCLUSIONS: Coordination of eye services with better integration of ophthalmology and optometry roles may improve efficiency of services for patients. Coordination of eye services has multiple facets including facilitating engagement with the local community, eye professions and health facilities. The varied roles of eye health coordination require further definition and appropriate funding.

Eye health service access and utilization in the National Indigenous Eye Health Survey.

BACKGROUND: To determine access to and utilization of eye health services for indigenous Australians. DESIGN: A national, stratified, random cluster sample was drawn from 30 communities across Australia that each included about 300 indigenous people. PARTICIPANTS: A total of 1189 indigenous adults aged 40 and above were examined, representing 79% of the target population. METHODS: Eye health services data including nature and availability of facilities and workforce supply were collected for comparison with eye health prevalence data. The data were collected in 2008. MAIN OUTCOME MEASURES: Low vision prevalence and coverage rate for distance refractive correction. RESULTS: The full-time equivalent availability of an optometrist working in an Aboriginal Medical Service was significantly associated with both a decrease in the prevalence of low vision (t = -2.41, P = 0.02) and an increase in the coverage rate for distance refractive correction (t = 2.99, P = 0.006). These associations were not replicated when comparing availability of private or hospital-based optometry in each community. Regional eye health coordinators appeared to provide an improved utilization of Aboriginal Health Services and therefore improved access to Aboriginal medical service optometry. CONCLUSIONS: Eye health services for indigenous Australians need to be provided in culturally appropriate facilities with clear links to the indigenous community to optimize access to care and reduce the prevalence of vision impairment. The adequate provision of accessible eye care services is an important component in 'closing the gap' in vision loss for indigenous Australians.