Can health economics be a useful tool in the fight against policies detrimental to the eye care profession?


Andrew Smith, M.Sc. Ph.D.

In recent years, demographic and technological features have combined to produce a vast and complicated healthcare landscape, one which is undoubtedly challenging to the many who work in it and the many who use its services.  Amongst industrialized countries, for example, rising life expectancy, an aging population and an increased array of ever more sophisticated medical and pharmaceutical interventions has prompted many healthcare regulators to evaluate the value of such intervention against the backdrop of increasingly scare economic resources.

Richard Hom OD, MPA


In practical terms,  demand for healthcare will rise steeply in the coming decades and in order to prevent the commensurate rise in the cost of health care, health care agencies around the globe are  delisting healthcare procedures and dropping reimbursement expenditures for others procedures. In the eye care arena, for example, such moves may backfire as many of the diagnostic devices essential to the treatment and management of eye care patients come under increasing cost pressure.

The eye care sector is not immune from the general economic malaise and it is essential that rigorous scientific evaluation attempt to ensure that those eye care interventions, be they diagnostic, or interventional of one form or another do not run the risk of backfiring in the sense of being a “penny wise and pound foolish”.It is not about targeting the larger upfront costs of increasingly accurate diagnostic testing in eye care such as for OCT, VF, and HRT imaging technology. It is about the potentially larger downstream costs of delayed or incorrect diagnosis and treatment of clinically significant, glaucoma, diabetic eye disease or treatable ARMD.

In fact, what is needed is a means of appropriately evaluating the value of such eye care diagnostic and interventional technology relative to competing technologies and interventions. Health economics, a relatively new discipline, provides a  powerful tool to perform a rigorous evaluation not just of the short term cost savings associated with forgoing one or another diagnostic test or technology, but of the total downstream costs and effectiveness of competing interventions and diagnostic tests. By considering all of the costs and all of the health effects over the timeframe of the intervention, a fairer assessment of the allocation of resources might be made than a much foreshortened analysis which focuses solely on upfront costs such as the acquisition of relatively expensive diagnostic technologies.

In summary, too myopic a focus of such current decision making processes will fail society as a whole. A balance, therefore, between individual eye care needs and overall societal goals must prevail. Ultimately, health economics studies can provide a useful means of better understanding the value of medical devices and technologies from both the patients and manufactures of such technologies perspectives. Perhaps most importantly, health economic evaluations provide a transparent scientific methodological framework to validate arbitrary decisions making to de-list or reduce reimbursement for eye care diagnostic technologies and interventions.

Andrew F. Smith, PhD (1,2), Richard Hom, OD, MPA (3)

  1. Medmetrics Inc., 30 Charles Street, Ottawa, Ontario, Canada, K1M 1R2
  2. Adjunct Professor (Health Economics), McGill University, Montreal, Quebec, Canada
  3. Optometric and Public Policy Consultant, San Mateo, California, USA

About Richard Hom OD, MPA

Dr. Hom holds Doctor of Optometry and Masters in Public Administration degrees and practices family eye care and consults on public policy, health information technology and program evaluation.
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