Orthoptists Services: A Review of Benefits Paid By Medical Schemes, South Africa

Abstract

Background: Orthoptists are specialists in diagnosing and treating ocular movement disorders and problems related to how the eyes work together, known as binocular vision. There is currently about 1 100 orthoptist registered and working in the UK. The comparative figure to South Africa is much lower at only nine registered orthoptists. Study design and objectives: This was a cross-sectional research study of claims paid for Orthoptists services by medical schemes. The study's primary objectives were to assess benefits paid for Orthoptists services, the level of co-payment subjected to members of medical schemes, and the funding model employed by medical schemes. The study entailed secondary data collected from the Council for Medical Schemes Annual Statutory returns. Results: The total number of beneficiaries with at least one orthoptist visit was 204, and the total number of visits paid by schemes was 256. This translates to the average number of one visit per beneficiary per annum. Each visit amounted to an average expenditure of R540. These services attracted a co-payment to the rand amount of R148 per visit. Nearly half of these benefits were paid from the person's medical savings account, accounting for 48% of benefits. Conclusion and recommendations: Coupled with evidence that there are currently no training schools for orthoptists and a low revenue base, this study shows that the demand for the services is lower than in previous years. The study recommends a review of the current model to a more multidisciplinary team across all specialties, particularly seeing that the first world countries still utilise the services of orthoptists in various health sectors, including child development and mainstream schools.

Eye care services and benefits paid by medical schemes in South Africa

“…Non-health care spending varies per administrator based on member profile, the number of benefit options and scheme type. 19,26,29,53 The effect of network arrangements on funding eye care services was also investigated in this study.…”

“…27 The evidence from the Council for Medical Schemes (CMS) demonstrates that these medical service providers have a low base of claims, with fewer than 10 orthoptists currently practising in South Africa. 28,29…”

“…In South Africa, there are essentially no orthoptist networks because of the fact that there are just nine individuals registered with the HPCSA. 28,29 There is also evidence that most of them have emigrated, and of the nine registered orthoptists (five orthoptists in Gauteng, three in the Western Cape and one in KwaZulu-Natal as of 2020), only a few are claiming from medical schemes. 26,28,29 In comparison, approximately 100 orthoptists are registered to practise and are employed in the UK.…”

“…28,29 There is also evidence that most of them have emigrated, and of the nine registered orthoptists (five orthoptists in Gauteng, three in the Western Cape and one in KwaZulu-Natal as of 2020), only a few are claiming from medical schemes. 26,28,29 In comparison, approximately 100 orthoptists are registered to practise and are employed in the UK. 45 Another aspect contributing to this situation is that there are currently no training facilities in South Africa for the discipline.…”

“…45 Another aspect contributing to this situation is that there are currently no training facilities in South Africa for the discipline. 28,29 Out-of-benefits upgrades Medical schemes provide optical benefits, mainly for basic lenses and frames. 30 These are funded to a specific limit and are also a function of the benefit option.…”