HSE Funded Primary Care Treatments and Claims, 2017-2021

Introduction

The Primary Care Reimbursement Service (PCRS) within the HSE is responsible for reimbursing optometrists and ophthalmologists under the Health Service Executive Community Ophthalmic Services Scheme (COSS). Within this scheme, eligible persons under the GMS scheme and their dependants are entitled, free of charge, to optical treatments and necessary spectacles/appliances. Optical treatments range from new appliances (including glasses and contact lenses) to eye examinations and medical optical treatments. Claims for spectacles provided under the Children’s Scheme are also paid under the scheme.  

Please see Background Notes for a further description of GMS and Community Ophthalmic Services Scheme (COSS). The figures in this release are based off fully complete and processed claims under the GMS. For this reason, figures may vary from those published by the HSE. Please note, care should be taken when examining trends over time in the form of expenditure and average amounts as eligibility criteria can change over time.

The cost of HSE funded optical treatments fell from €31.1 million in 2017 to €24.2 million in 2021

The number of HSE funded optical treatments fell from approximately 787,000 in 2017 to 616,000 in 2021, equating to a fall of over a fifth in the number of HSE funded optical treatments over the period. This is a 22% decrease in the number of HSE funded optical treatments from 2017 to 2021. The cost of optical treatments fell from €31.1 million in 2017 to €24.2 million in 2021, also a fall of over a fifth. The average cost per optical treatment and average number of optical treatments per person were remained steady between 2017 and 2021. See Figure 4.1 and Table 4.1.

Three in five HSE funded optical treatments were for females in 2021

Three in five HSE funded optical treatments were for females in 2021, with females receiving approximately 371,000 optical treatments in 2021 in comparison to approximately 245,000 treatments for males in the same year. The decrease in the number of optical treatments between 2017 and 2021 was seen across all age ranges, apart from people aged 24 and under, where there was a 48% increase in the number of treatments between 2017 and 2021. Within the regional areas, the largest percentage decrease in the number of optical treatments was seen in Dublin North East Local Health Office region at 30%. See Figure 4.2 and Table 4.2.

Over half of all HSE funded optical treatment costs were for patients who were 65 years and over in 2021

The cost of HSE funded optical treatments in 2021 was €24.2 million. Of this, over half or €12.9 million was for optical treatments for persons who were aged 65 years and over. Less than 3% of costs for HSE funded optical treatments were for those aged 25 to 34 years. The cost of HSE funded optical treatments for females, accounted for 61% or €14.7 million of the costs in 2021. The South LHO region accounted for 30% of the HSE funded optical treatment costs at €7.2 million.

Between 2017 and 2021, the total cost of HSE funded optical treatments decreased by 20% for females, from €18.4 million to €14.7 million, and 25% for males, from €12.7 million to €9.5 million. The highest proportional decrease in HSE funded treatment costs was seen for persons aged 35-44 years, with a 37% decrease between 2017 and 2021. The lowest proportional decrease in HSE funded treatment costs was seen for persons aged 75 years and over, with a 21% decrease between 2017 and 2021. See Figure 4.3 and Table 4.3.

Appliances (including glasses and contact lenses) amounted to 57% HSE funded optical treatments in 2021

The supply of appliances, such as glasses and contact lenses, are the most popular HSE funded optical treatment making up approximately 349,000 or 57% of optical treatments in 2021. The second most commonly performed optical treatment is eye examinations, making up approximately 220,000 or 36% of HSE funded optical treatments in 2021. Other treatments, home visits, medical optical treatment, and repairs and replacements make up around 8% of annual treatments in 2021. 

HSE funded optical treatments are consistently higher among females than males during the years 2017 to 2021. Appliances (including glasses and contact lenses) were the most popular optical treatments for the 0-24 years cohort, making up 76% of optical treatments for this cohort. In 2021, 8% of optical treatments for those aged 75 years and over were medical optical treatments in comparison to 4% for the overall population.

In 2021, claims related to appliances and eye examinations were highest in the South LHO region. Home visits by optometrist/ophthalmologist and medical optical treatments were highest in the Dublin Mid-Leinster LHO regions. See Figure 4.4 and Table 4.4.

The average number of HSE funded optical treatments was highest for those aged 75 and over

The average number of optical treatments per patient were 1.3 optical treatments in 2021. Those aged 25-34 averaged 1.1 optical treatments per patient in 2021 while those aged over 75 years averaged 1.4 optical treatments per patient in the same year. The average number of optical treatments per patient were highest in the Dublin Mid-Leinster and South LHO regions in 2021 at 1.3. See Table 4.5.

Average payment per HSE funded optical treatment steady between 2017 and 2021

The average payment per HSE funded optical treatment was steady between 2017 and 2021, increasing slightly from €38.86 in 2017 to €38.90 in 2021. The average payment per optical treatment was slightly higher for females than males in 2021, at €39.19 and €38.47 respectively.

In 2021, the average payment per optical treatment was lowest for those under 24, at €29.62 and highest for those over 75 at €42.14. The Dublin Mid-Leinster LHO region saw the highest average payments per optical treatments at €40.38 in 2021. See Table 4.6.