Australian Optometrical Association President Arthur Ley (R) and vice president Brian Layland (L) were in the House of Representatives when the bill was returned to the House and accepted. They are pictured leaving the Chamber with MP Len Reynolds.
By Helen Carter
This year marks the 40th anniversary of optometry being included in Medicare, a momentous achievement that has given millions of Australians access to quality government-subsidised eye care from optometrists.
Optometry was included in Medicare, then called Medibank, when an act to amend the Health Insurance Act 1973 was passed by the Senate of the Commonwealth Parliament on 10 June 1975.
The association fought tenaciously for the introduction of optometry into the national health system and has continued to lobby for Medicare rebates for optometry to be retained and expanded over the past four decades.
There were four Medicare items for optometry in the schedule to the 1975 Act. There are now 32 items, due to the ongoing advocacy work of Optometry Australia preparing submissions and lobbying government for additional item codes.
The association’s executive director at the time, Dr Damien Smith, recalls the event. ‘Dr Jim Cairns, the deputy Prime Minister, announced at an international optometry conference in Melbourne in May 1974 that optometry was to be included in Medibank, and said the government had “no reservations” or words to that effect about the qualifications of optometrists,’ he said.
‘This was a very heart-warming comment for the practitioners of the day who were completely suppressed by ophthalmology. Recent generations of optometrists take their status for granted but their predecessors were unrecognised as a proper health profession.’
In October 1975 at the association’s annual general meeting in Adelaide, Australian Optometrical Association national president, Arthur Ley said:
‘It is with utmost satisfaction that I report that our main objective for nearly one quarter of a century, inclusion into the national health insurance scheme in Australia, has been achieved.’
The comments were recorded in Mr Ley’s annual report and published in the Australian Journal of Optometry in November 1975. In the same journal issue, Dr Smith said in his annual report: ‘Without doubt 1975 has been a momentous year for optometry.
‘We have gained new status with government departments. We are no longer looked upon as some fringe or eccentric group with a chip on its shoulder. We are regarded as a responsible, co-operative profession served by a credible, authoritative and straight-dealing professional association.’
The Labor Government introduced the benefits after much consultation with the association.
On 26 September 1975, a dinner to celebrate optometry’s entry into Medibank, now Medicare, was attended by the Australian Optometrical Association National Executive Council (L-R) Lloyd Hewett, William Ure, Charles Wright, national president Arthur Ley, Ronald Fieldhouse, Brian Carlton Smith, Brian Layland, Bruce Besley and executive director Dr Damien Smith
The achievement was due to the hard work of the association’s national executive council, particularly Dr Smith, Mr Ley, vice-president Brian Layland and council member Bruce Besley who were hugely instrumental in the process.
Charles Wright’s History of Australian Optometry records that Dr Smith worked on the complex submissions required to define and win optometry’s place in the national health scheme.
Later, ‘Ley, Smith and company got on with the new business working with the re-elected Government to achieve, not what was best for optometry, but what would be best for the people of Australia.
The archival papers show few, if any, signs that optometry’s interests were pressed and I am sure they were never advanced over the public interest,’ Mr Wright wrote.
Optometrist Malcolm Miller also assisted, writing a paper to help the association negotiate fees with the government.
South Australia Liberal Senator, optometrist Don Jessop was instrumental in lobbying politicians and disarming opposition from the Liberal party.
Senator Jessop and Dr Smith were in the Senate Chamber when optometry joined the national health scheme and Mr Ley and Mr Layland were in the House of Representatives when the bill was returned to the House and accepted.
Social Security Minister Bill Hayden said MP Len Reynolds was ‘the one to thank, he kept pushing away at it all those years.’
In February 1984 Medibank was renamed Medicare and in September 1991 Medicare announced it would pay the same benefit for spectacle prescription consultations whether by an optometrist or ophthalmologist.
Keating axes optometry
The association mounted its biggest campaign in 1993 to fight a Keating Government decision to exclude optometry from Medicare for all residents with the exception of aged pensioners and health card holders.
After a brief but intense campaign that harnessed the support of the community, the association won and in October 1993 the Labor caucus overturned its earlier decision.
Software updates by Optomate and Sunix Vision in September 2006 delivered almost instant processing of Medicare claims at practice sites and direct payment of rebates into patient bank accounts.
Legislation was passed to include optometric prescriptions in the Pharmaceutical Benefits Scheme in October 2007, the same year that Medicare’s Easyclaim system started.
Medicare indexation was frozen in 2014 and is to remain frozen until 2018. In May 2014 it was announced in the Federal Budget that there was to be a five per cent cut to patient rebates, which came into effect on 1 January 2015, together with a reduction in access to comprehensive eye health examinations from once every two years to once every three for patients 65 years and younger.
The Eye Care for All Campaign by Optometry Australia is opposing these changes and has mounted a patient petition.
As announced in the same Federal Budget, patients older than 65 years can now access a comprehensive eye health examination annually.
Optometry Australia advocacy convinced the government to remove the fee cap, with effect from 1 January 2015.
In their editorial in Clinical and Experimental Optometry, Optometry Australia CEO Genevieve Quilty and Emeritus Professor Barry Cole said that including optometry in Medicare was and still is of the greatest importance to those who need ready access to primary eye health and vision services.
- Medicare 40 years on: a privilege for the profession and a right for its patients. Clin Exp Optom 2015; 98: 4: 297-298.