Even when she squints, 10-year-old Dunia Katoub can’t quite see what her teacher writes on the school blackboard. She needs an eye exam, but is unable to do so, despite her parents’ best efforts.
She is one of thousands of children, teens and seniors who have been denied vision care amid the ongoing fight between Ontario optometrists and the provincial government. When the screening can be done depends largely on when the Health Department reaches a deal with the Ontario Association of Optometrists, which stopped providing services on Sept. 1 due to long-standing funding disputes.
The beginning of school made it clear that Dunia’s eyesight had deteriorated and she needs a new prescription, said her father, Mohamad Katoub. He began calling the optometry offices in Kingston, where his family lives, to schedule an appointment, only to be turned away over and over again.
Finally, he got one through an online reservation system at a clinic that apparently had open spaces. When they arrived on Saturday, they were informed that the optometrist would not see Dunia. The receptionist explained that optometrists across the province are not examining patients covered by OHIP, due to a labor action protesting inadequate government funding.
“Dunia felt that she had been abandoned from a service she deserves,” Katoub said. “She hoped this problem would be solved this week … She needs to see and have the same vision as her colleagues.”
Katoub offered to pay out of pocket, but was refused; It is illegal in Ontario for optometrists to accept personal payments, private health insurance, or at the workplace for age groups covered by OHIP.
Dunia’s teacher has moved her to a chair closer to the front of the class, but there are materials that she can only read with the help of friends at school, her father added. On Monday, Katoub called his outpatient clinic and asked to see a doctor for a referral to an ophthalmologist. The clinic rejected her request and suggested that she take her daughter to an emergency department.
While adults pay for eye exams out of pocket or through insurance, exams for children and seniors are covered by the Ontario Health Insurance Plan. The money that OHIP pays to optometrists per exam has barely budged for many years and now covers about half of the costs. The Health Ministry says its proposals are reasonable, including a balloon payment.
Katoub is a dentist, humanitarian activist and researcher for the Syrian Impact Study at the University of California Berkeley School of Public Health. Having investigated and experienced problems like this that became politicized “at the highest level” in Syria, he was surprised to see that his family was feeling the impact of a political-health clash in Ontario.
“I did not expect the government to ignore the demands of a group that provides valuable services to people, or that the health workers who provide the services are simply cutting off the service because they are not getting what they want,” Katoub said. “This is the health of our children.”
Sheldon Salaba, president of the Ontario Association of Optometrists (OAO), said he has empathy for families facing lack of access to eye care. But it took the withdrawal of services to convince the government to react and hopefully fix “a broken system,” he said.
“For those of you who are experiencing delays, I apologize. We don’t want to do this to them. “
The OAO estimates an average participation rate of 95 percent in work action for optometrists. About 250,000 appointments have been canceled since Sept. 1, with about 15,000 exams daily, and the province is experiencing delays in referrals for cataract surgery in the range of 2,000 per week, Salaba said.
After the Health Ministry rejected a proposal to work with the OAO on a study reviewing the operating costs of optometry offices in the province last December, the association said it commissioned an independent study from a national accounting firm ( BDO). The firm determined that the average operating cost to provide an eye exam in Ontario was $ 75.51 in 2019, not including doctor’s compensation.
Overall costs can vary by region, said Hamilton-based optometrist Tyler Brown, but typically ranges from $ 75 to $ 80. In downtown Toronto, it can go as high as $ 95, while in more rural areas it’s closer to $ 70, he said. That number primarily reflects staff and rental expenses. Another important factor is the price of buying and maintaining expensive instruments that are used for eye exams, such as OCT machines that scan the back of the eye and the layers of the retina for disorders and can cost hundreds of thousands of dollars.
Under current cost structures, the province reimburses 55 percent for each OHIP-covered eye care exam, forcing optometrists to pay the rest.
That brings the total reimbursement to about $ 44, if the operating cost is $ 80. In 1989, the province paid about $ 39 per exam, so the switch to funding over three decades is about $ 5. .
All requests from the OAO for the ministry to address the lack of funds, enter a formal negotiation process and “at the very least” cover the operational costs of providing services were ignored, Salaba said. So on March 30, 96 percent of Ontario optometrists voted to stop providing OHIP-covered vision care services beginning in September, unless the government agreed to binding negotiations.
In August there was a virtual meeting and two days of mediation.
Then, on August 17, Health Minister Christine Elliott issued a statement. It announced a proposed $ 39 million balloon payment to Ontario’s roughly 2,500 practicing optometrists, which the ministry said would cover a retroactive period over the past decade.
Salaba said that optometrists performed 34 million services in the last decade, so the one-time back pay averages just over $ 1 per optometry service.
“That was not a negotiated proposal. It’s not something we’re asking for and I think it’s a huge waste of taxpayer money, “he said. Salaba added the public launch One of the offers discussed in the mediation session was a bad faith negotiation.
“They are playing right now.”
On August 23, Elliott tweeted an open letter to Ontario optometrists. He outlined proposals for the OAO in addition to the $ 39 million, including a commitment to a joint task force supported by a mediator and an 8.48 percent increase at the rate code level.
Like other healthcare providers, optometrists must enroll in the Electronic data transfer service for medical claims, allowing them to submit claims electronically for reimbursement for OHIP-insured services. Claims are submitted using rate codes, which represent the service provided. They typically submit those claims once a month, Tyler Brown said. The government then reviews the claims and provides reimbursement once approved.
The proposed 8.48 percent increase at the rate code level means the ministry is willing to reimburse optometrists an additional 8.48 percent for each service they provide. This does not include paying the optometrist for the service or reaching a level of funding that covers the operating costs of these services. It would only move the average reimbursement for an eye exam from around $ 44 to $ 48, requiring the average optometrist to pay even more than $ 30 to examine an OHIP-insured patient, says Salaba. It leaves the province far behind others in government funding for vision screening services for the elderly specifically, he added.
In Manitoba, the province with the second lowest funding, the government reimburses $ 77.18 of the total cost. To match Manitoba, Ontario would have to increase compensation by 65 to 70 percent, Salaba said.
The province has not contacted the OAO since the start of the labor action, he added.
A ministry spokesman said Wednesday that the OAO recently rejected the terms of an outside mediator that would allow the parties to resume mediation.
The spokesperson added that the “fair and reasonable” proposal presented “is designed to take immediate action to address years of negligence and represents a starting point for future discussions.” While the ministry waits for the OAO to “come back to the table,” optometrists will receive $ 39 million as part of their October OHIP payments, regardless of whether there is an agreement, the spokesperson said.
The College of Optometrists of Ontario politics for services during the labor action, states must help patients “make alternative arrangements, which may include referring patients to another provider of care.”
Salaba said there is currently no trust between the OAO and the government that would encourage the association to participate in the proposed deal. The optometrists will not end the labor action until the government agrees to ensure that the operating costs of eye exams are fully covered and that the province does not “receive the worst funding in the entire country,” he added.
Detecting visual disturbances and problems at an early age, ideally under the age of 12, is critical, Brown said. If early intervention is not done, the problem can persist for life. In addition, 80 percent of learning is visual, which means that children’s education and development are affected, he added.
In the case of the elderly, optometrists aim to detect degenerative changes and conditions that, if not detected early on through a routine examination, can harm the quality of life of the elderly, even leading to blindness, Brown said.