Optometry in the Netherlands Annemieke Coops BOptom MPhil

Optometry in the Netherlands Annemieke Coops, BOptom MPhil Ph. D FAAO Senior advisor Dutch Optometric Association Trustee European Academy Optometry and Optics Treasurer Vision 2020 Netherlands

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Overview of what will be covered • Optometry in the Netherlands before legislation • Factors leading to legislation • Optometry in the Netherlands after legislation • Optometry in the Netherland in the future, possible scenarios

Optometry in the Netherlands before legislation

Optometry in the Netherlands before legislation • Dutch healthcare regulated by Medical Practice Act (1865) – Role of optician precisely laid down only refraction by trial frame allowed – Authorities turned a blind eye – Contact lenses not regulated – did not exist in 1865 • Education in optics, additional courses for contact lenses • 1988 4 -year optometry course based on UK system

Scope of Practice of Optometry Box 1 Turkey Box 2 Belgium France Iceland Italy Box 3 Austria Denmark Germany Spain Switzerland Box 4 Finland Ireland Netherlands Norway Sweden? Box 5 Australia Canada New Zealand Nigeria UK US OPTICIAN REFRACTING OPTICIAN OPTOMETRIST DOCTOR OF OPTOMETRY dispensing refraction prescription screening for eye disease dispensing refraction prescription diagnosis of eye disease using DPA’s (diagnostics) treatment of eye disease using TPA’s (therapeutics) © Feike Grit 2010

Changes needed in health care system ? 1988 Evaluation Implementation Education Legislation

Demographics of the Netherlands 1975 1995 - People are getting older - Older people need more health care - Baby boom after second world war - Less young people - less people who will bring in tax money to pay for health care

Percentage (%) of gross national product spend on health care h t l a s a e r Inc e h e re a c st o c

Cutler’s “three waves of health care reform” 1. universal coverage and equal access to health care (1940 – 1970) 2. cost control by the government via supply-side regulation (1970 – 2000) 3. efficiency via incentives and competition (2000 – to date)

Cutler’s “three waves of health care reform” 1. universal coverage and equal access to health care (1940 – 1970) 2. cost control by the government via supply-side 1941 –– 2000) introduction social insurance regulation (1970 3. efficiency via incentives and competition (2000 – to date)

Cutler’s “three waves of health care reform” 1. universal coverage and equal access to health care (1940 – 1970) 2. cost control by the government via supply-side regulation (1970 – 2000) 3. efficiency via incentives and competition (2000 – to date) replacing fee-for-service and openended reimbursement by price regulation and budgeting systems

Cutler’s “three waves of health care reform” 1. universal coverage and equal access to health Efficiency needed to reduce cost further care (1940 – 1970) Other care providers than 2. cost control by the health government via supply-side regulation doctors/medical (1970 – 2000) specialists 3. efficiency via incentives and competition (2000 – to date)

Cutler’s “three waves of health care reform” 1. universal coverage and equal access to health Efficiency needed to reduce cost further care (1940 – 1970) Other care providers than 2. cost control by the health government via supply-side regulation doctors (1970 – 2000) 3. efficiency via incentives and competition (2000 – 1992 – Optometry course officially recognised by ministry to date)of education 1996 – minister of health care decided to legislate optometry 2000 – optometric regulation and legislation

Changes needed in health care system Evaluation Implementation Education Legislation

Before legislation Refraction Contact lens management After legislation Screening for eye disease using diagnostics Examination of patients with chronic diseases Contact lens management

Before legislation Refraction Contact lens management After legislation Screening for eye disease using diagnostic drugs Examination of patients with chronic eye diseases Low vision examination and treatment Contact lens Binocular vision examination and management treatment

Changes needed in health care system Evaluation Implementation Education Legislation

Eye care in the Netherlands Number of healthcare providers per 10 K of population 900 631 Optometrists Ophthalmologists 0. 54 per 10 K 0. 38 per 10 K 3510 Opticians (refracting) 2. 13 per 10 K 350 Orthoptists 0. 21 per 10 K 8, 107 General practitioners 4. 91 per 10 K ? Ophthalmic technicians

Optometry in the Netherlands Approximately 900 optometrist 85% member of OVN (= Dutch optometric association) 3%3% Community Hospital 22% 72% Refractive surgery Not working in clinical practice

Community optometry Hospital optometry Community optometry more focused on refraction; also NCT more used Hospital optometry more focused on health care

Change over time in hospital optometry 1995 2000 Legislation Optometry recognised by law 2011

Variation in providing optometric services by optometrist Hospital optometry Pre-testing patients êVariation for ophthalmologist Independent decision by creating better guidelines making in patient care Joint effort, ophthalmology & optometry, in establishing referral criteria older generation younger generation Community optometry Visual function services Ocular diagnostic services (with DPA)

Connection between optometrists on regional level Community optometrist GP Ophthalmologist

Continuing professional development • Essential!! • Continuing education • Discussions with colleagues Quality registration Quality circles Professional guidelines

Optometry in the future

Demographics of the Netherlands 1995 2020

Demographics of the Netherlands 1995 2030 On average cost of healthcare with current system 2012 10% of income 2030 40% of income

Foreseeable changes for the future • Increased need for health care. – Eyecare: refractive error, cataract surgery, etc • More task delegation – ‘simple’ cases by other professionals – more time for complex cases for ophthalmologists • In Netherlands: Government stimulates diagnostic services outside hospital

Optometry in the future • Some examples of current movements in health and eye care and possible scenarios for optometry • The future will tell whether this comes true

Thank you for your attention!