title: Addressing inequalities in eye health with subsidies and increased fees for General Ophthalmic Services in socio-economically deprived communities: a sensitivity analysis.
abstract: OBJECTIVE
  Poor knowledge of eye health, concerns about the cost of spectacles, mistrust of optometrists and limited geographical access in socio-economically deprived areas are barriers to accessing regular eye examinations and result in low uptake and subsequent late presentation to ophthalmology clinics. Personal Medical Services (PMS) were introduced in the late 1990 s to provide locally negotiated solutions to problems associated with inequalities in access to primary care. An equivalent approach to delivery of optometric services could address inequalities in the uptake of eye examinations.
  
  
  METHODS
  One-way and multiway sensitivity analyses.
  
  
  METHODS
  Variations in assumptions were included in the models for equipment and accommodation costs, uptake and length of appointments. The sensitivity analyses thresholds were cost-per-person tested below the GOS1 fee paid by the NHS and achieving break-even between income and expenditure, assuming no cross-subsidy from profits from sales of optical appliances.
  
  
  RESULTS
  Cost per test ranged from £ 24.01 to £ 64.80 and subsidy required varied from £ 14,490 to £ 108,046. Unused capacity utilised for local enhanced service schemes such as glaucoma referral refinement reduced the subsidy needed.
  
  
  CONCLUSIONS
  In order to support the financial viability of primary eye care in socio-economically deprived communities, income is required from additional subsidies or from sources other than eye examinations, such as ophthalmic or other optometric community services. This would require a significant shift of activity from secondary to primary care locations. The subsidy required could also be justified by the utility gain from earlier detection of preventable sight loss.
authors.affiliation: University of Leeds, UK. Electronic address: d.shickle@leeds.ac.uk.
authors.forename: Darren
authors.initials: D
authors.lastname: Shickle
authors.affiliation: University of Leeds, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Todkill
authors.affiliation: University of Bradford, UK.
authors.forename: Catharine
authors.initials: C
authors.lastname: Chisholm
authors.affiliation: Royal National Institute of Blind People, UK.
authors.forename: Sonal
authors.initials: S
authors.lastname: Rughani
authors.affiliation: University of Leeds, UK.
authors.forename: Marcus
authors.initials: M
authors.lastname: Griffin
authors.affiliation: Leeds Teaching Hospital Trust, UK.
authors.forename: Andy
authors.initials: A
authors.lastname: Cassels-Brown
authors.affiliation: Royal National Institute of Blind People, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: May
authors.affiliation: University of Leeds, UK.
authors.forename: Sarah V
authors.initials: SV
authors.lastname: Slade
authors.affiliation: University of Leeds, UK.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Davey
mesh_terms: D000368:Aged; D005260:Female; D005380:Financing, Government; D005102:Health Expenditures / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics*; D054624:Health Status Disparities; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000191:economics*; D011204:Poverty Areas; D011320:Primary Health Care / Q000191:economics; D012959:Socioeconomic Factors; D013222:State Medicine
keywords: Eye disorders; Health economics; Health services; Screening; Sensitivity analysis