EYE CARE SERVICE IN SCOTLAND: Did the Scots get it right?

The introduction of free eye care in Scotland, in the form of a removal of user charges, has resulted in a mixed response from people in Scotland and a widening of inequalities in eye care utilisation. These are the central findings of a Chief Scientist Office funded research project by the University of Aberdeen Business School and the Health Economics Research Unit, to be presented at the Royal Economic Society''s annual conference 2015.

In general, the demand for health care services is higher among individuals with high levels of education and income. The research team – Heather Dickey, Divine Ikenwilo, Patricia Norwood, Verity Watson and Alexandros Zangelidis – find this is also true for the utilisation of eye care services in Scotland. Their results confirm that there is a clear relationship between education and income and the demand for eye care services.

In April 2006 the Scottish Executive, working towards the VISION 2020 declaration of eliminating avoidable blindness by 2020, introduced free eye-care in Scotland and commissioned private ophthalmic optician practices to perform eye examinations. The examination optometrists provide is a thorough examination to assess the patient''s eye health, which provides a benefit to all individuals not only those requiring spectacles. The introduction of free eye-care was expected to encourage wider use of optometry services in Scotland. No other country seems to have implemented a policy the same or similar to the Scottish policy.

The research team, with the financial support from the Chief Scientist Office (grant: CZG/2/533), evaluated the impact of this policy in Scotland. Specifically, by investigating people''s responses to the policy and exploring the socio-economic differences in the utilisation of the free eye-care. This is the first project of its kind to evaluate the effect of policy changes on the utilisation of eye-care services in Scotland.

One of primary aims of the Scottish government''s changes to eye-care policy was to encourage more of the Scottish population to have their eyes tested. This study investigates the response to the policy and finds an increase in eye care utilisation among high income individuals only (top 25% of the income distribution), but no evidence of increased eye tests among the rest of the Scottish population.

The effectiveness of the policy will further depend on its impact across different groups within society. Studies within health services research point to adverse distributional consequences of policy changes as people''s responses will vary across different population groups.

This study similarly reveals differences across socio-economic groups. While socio-economic groups associated with higher income responded positively to the policy, those from low and middle income households did not. Not only is the utilisation of eye tests lower for people with low education and those from poorer households, but the lack of response to the policy change by these subgroups of the population has caused inequality in eye-care utilisation to widen.

The findings indicate that policy-makers should focus on the more vulnerable segments of society in order to alleviate this inequality in utilisation. More effort could be devoted on informing the public about the free eye-care policy and educating them about the benefits of an eye examination. Another policy option to encourage lower income individuals to take up the free eye examination would be to subsidise the cost of treatment (the cost of spectacles, contact lenses, and other eyecare-related products) as well as the cost of examination.