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Access to ophthalmology services: Exploration of barriers and recommendations for shortening waiting times
Researchers: Rachel Wilf-Miron1
- Gertner Institute for Epidemiology and Health Policy Research
Background: Long waiting times (WT) in the public healthcare system adversely affect health and patient satisfaction, and increase the use of private healthcare. In light of substantial geographical disparities in WT, a study was planned to assess the process of appointment scheduling and wait times for various ophthalmology services, on the community-hospital continuum.
Objectives: Characterization of disparities and barriers in appointment scheduling for community ophthalmologists, diagnosis and treatment of Age-related Macular Degeneration (AMD) and cataract surgery;; proposal of intervention directions to shorten WT and increase equity in ophthalmology from a national perspective.
Method: Analysis of interviews conducted with ophthalmologists and administrators from two HMOS and 10 hospitals; survey data collected during 2019-2020; and administrative data obtained from all community ophthalmology clinics.
Findings: Community appointments
• Less need for community ophthalmology appointments was reported in the Southern district and in the Arab population.
• WT increased with age
• 69% of survey respondents considered their WTto be reasonable.
• A negative association was found between physician -hours per 1000 population and WT, being strongest in the Southern district, where additional hours would have the greatest impact on WT.
AMD diagnosis and treatment
• A lack of retinal specialists was described in the Northern district, leading to long WT and delays in initiation of injections in those diagnosed with wet-AMD.
• Where WT for outpatient clinics are long, physicians often refer patients through the ED in order to shorten WT and expedite treatment.
• AMD patients without complementary insurance who require second line treatments have difficulty financing the medicine. Some mechanisms are in place to help in these cases.
Cataract
• The case mix in public hospitals includes more complex cases compared to private hospitals, which may lengthen WT in the public system.
• Bottlenecks in the system are related to long WT for outpatient clinics and insufficient capacity of operating theatres.
• There is difficulty in regulating demand between hospitals due to agreements between HMOS and hospitals.
• Low DRG tariffs for cataract surgery make it difficult to compensate medical teams for out-of-hours work, which would shorten WT.
• Less need for community ophthalmology appointments was reported in the Southern district and in the Arab population.
• WT increased with age
• 69% of survey respondents considered their WTto be reasonable.
• A negative association was found between physician -hours per 1000 population and WT, being strongest in the Southern district, where additional hours would have the greatest impact on WT.
AMD diagnosis and treatment
• A lack of retinal specialists was described in the Northern district, leading to long WT and delays in initiation of injections in those diagnosed with wet-AMD.
• Where WT for outpatient clinics are long, physicians often refer patients through the ED in order to shorten WT and expedite treatment.
• AMD patients without complementary insurance who require second line treatments have difficulty financing the medicine. Some mechanisms are in place to help in these cases.
Cataract
• The case mix in public hospitals includes more complex cases compared to private hospitals, which may lengthen WT in the public system.
• Bottlenecks in the system are related to long WT for outpatient clinics and insufficient capacity of operating theatres.
• There is difficulty in regulating demand between hospitals due to agreements between HMOS and hospitals.
• Low DRG tariffs for cataract surgery make it difficult to compensate medical teams for out-of-hours work, which would shorten WT.
Conclusions: 1. Identify disparities in WT between geographical regions and between hospital ownership and to form appropriate recommendations.
2. Expand measurement to include the private healthcare sector.
3. The Ophthalmology Association might add a functional dimension to prioritization for cataract scheduling.
4. Set a WT target for cataract surgery, in collaboration with the Association of Opthalmologists.
5. Examine reasons for under-use of community eye specialists in the Arab population and in the South.
6. Formulate a solution for the older population who experience long WT.
7. Establish uniform mechanisms of assistance in all HMOs to allow patients without complementary insurance to obtain second-line AMD treatments.
8. Promote an equitable spread of opthalmologists and retinal specialists throughout the country.
9. Examine alternative routes for the use of ED resources to expedite AMD treatment .
10. Formulate a campaign in collaboration with the Ophthalmology Association to promote early self-diagnosis of AMD.
2. Expand measurement to include the private healthcare sector.
3. The Ophthalmology Association might add a functional dimension to prioritization for cataract scheduling.
4. Set a WT target for cataract surgery, in collaboration with the Association of Opthalmologists.
5. Examine reasons for under-use of community eye specialists in the Arab population and in the South.
6. Formulate a solution for the older population who experience long WT.
7. Establish uniform mechanisms of assistance in all HMOs to allow patients without complementary insurance to obtain second-line AMD treatments.
8. Promote an equitable spread of opthalmologists and retinal specialists throughout the country.
9. Examine alternative routes for the use of ED resources to expedite AMD treatment .
10. Formulate a campaign in collaboration with the Ophthalmology Association to promote early self-diagnosis of AMD.
Research number: MM/4/2019
Research end date: 10/2021