title: Spectacle dispensing in Timor-Leste: tiered-pricing, cross-subsidization and financial viability.
abstract: OBJECTIVE
  To examine the financial viability of the Timor-Leste National Spectacle Program as it increases spectacle availability, affordability and uptake, particularly for Timor's poor.
  
  
  METHODS
  In rural areas, three models of ready-made spectacles were dispensed according to a tiered pricing structure of US$3.00, 1.00, 0.10 and 0.00. In addition, custom-made spectacles were available in the capital, Dili. Spectacle costs, dispensing data and income for the National Spectacle Program for 18 months from March 2007 were analyzed.
  
  
  RESULTS
  Rural services dispensed 3415 readymade spectacles: 47.1% to women, and 51.4% at subsidized prices, being 39.8% at US$0.10 and 11.6% free. A profit of US$1,529 was generated, mainly from the sale of US$3.00 spectacles. Women (odds ratio, OR, 1.3, 95% confidence interval, CI, 1.1-1.4) and consumers aged ≥65 years (OR 2.1; 95% CI 1.7-2.6) were more likely to receive subsidized spectacles. Urban services dispensed 2768 spectacles; mostly US$3.00 readymade (52.8%) and custom-made single vision (29.6%) units. Custom-made spectacles accounted for 36.7% of dispensing, but 73.1% of the US$12,264 urban profit. The combined rural and urban profit covered all rural costs, leaving US$2,200 to meet administration and other urban expenses.
  
  
  CONCLUSIONS
  It is instructive and encouraging that a national spectacle dispensing program in one of the ten poorest countries of the world can use tiered-pricing based on willingness-to-pay information to cover spectacle stock replacement costs and produce profit, while using cross-subsidization to provide spectacles to the poor.
authors: The Fred Hollows Foundation New Zealand, Auckland, New Zealand.
authors: Jacqueline
authors: J
authors: Ramke
authors: Garry
authors: G
authors: Brian
authors: Anna
authors: A
authors: Palagyi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005139:Eyeglasses / Q000191:economics* / Q000600:supply & distribution*; D005249:Fees and Charges; D005260:Female; D005380:Financing, Government / Q000191:economics*; D005382:Financing, Personal / Q000191:economics*; D019538:Health Care Surveys; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration*; D011305:Presbyopia / Q000453:epidemiology / Q000628:therapy; D012030:Refractive Errors / Q000453:epidemiology / Q000628:therapy; D012424:Rural Population / Q000706:statistics & numerical data; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult