This report was authored by the Deloitte Center for Health Economics working with Roche and IAPB
1. The investment in eye health to prevent sight loss report makes a serious argument and a case about the need for investment in eye health from governments. What are the key questions explored in this report?
This project has three key objectives, which are to:
Collect data to inform an understanding of expenditure on eye health and eye health/vision outcomes across different countries, with the aim to collaborate with the IAPB to enrich the Vision Atlas
Contribute to IAPB’s key priorities to raise awareness for eye care, enable data and information sharing, strengthen international collaboration and further educate the public and governments on eye health
Undertake an assessment of the feasibility of designing a sustainable database to enable ongoing additions and tracking of information across countries, as well as define key messages to support broader coalition building between public and private organisations.
Based on the objectives of this project, the following key research questions were designed and developed in collaboration with eye healthcare subject matter experts:
What proportion of overall health expenditure in countries is allocated to eye health?
What are countries’ overall expenditure (per capita) on eye health? (breakdown by public funding, private funding & investment sources, estimated out of pocket funding by individuals & families?)
What are countries’ breakdown of expenditure and resource utilization on eye health?
What is the mix of expenditure on preventing and managing eye disease?
How does expenditure compare to eye health needs in a country?
What is the relationship between countries’ level of expenditure on eye health and prevention and vision outcomes achieved (e.g., rates of vision impairment and blindness)? What is the level of expenditure that is necessary to achieve good outcomes?
2. Which were the ten countries included in the analysis, and why were they selected?
Canada, the United States (US), Italy, Sweden, the United Kingdom (UK), India, Nepal (case study), Australia, Japan and Singapore.
In the initial stages of the project, a feasibility scoping task was undertaken from a larger number of countries (18 in total). The above 10 countries were shortlisted.
Countries were shortlisted based on one or more of four criteria:
Data availability: What data exists to support answering each indicator of the analytical framework?
Data quality: What is the condition of the data based on its accuracy, completeness, reliability and how recent the data was collected, to inform each indicator of the analytical framework?
High prevalence of sight loss: Which countries have relatively high prevalence of sight loss?
Unique eye health system and approach to vision care: What component of that country’s eye health system (and more broadly the health system) and approach to vision care can be used as a learning for other countries to improve access to care and outcomes?
3. What drivers of eye health needs are considered in this report? Could you state some findings that particularly stood out in the analysis?
There is significant variation in the structure and focus of eye health systems worldwide. This study has identified four key areas of the eye health system that require sustained and growing investment and can have a substantial impact on the eye care and eye health outcomes. They include:
Information: Reporting of comprehensive eye health data
Leadership: Creation of a national plan applying to eye health
Workforce: Adequate supply of eye care professionals to meet population need
Services: Focus on preventative eye care
4. How have you defined eye health expenditure in the report and what should we know about the report’s findings on eye health expenditure among the countries studied?
The definition of expenditure used in this report is the final consumption of health care goods and services, including personal health care (curative care, rehabilitative care, long-term care, ancillary services and medical good) and collective services (prevention and public health services as well as health administration), but excludes spending on investments. This definition is consistent with the definition used by the Organisation for Economic Co-operation and Development (OECD).
Data availability across countries is variable and there is a need for greater investment in eye care to address the growing burden.
5. The report speaks to targeted investment to drive change and influence eye health outcomes. What were the key gaps identified around eye health investment?
What proportion of health expenditure is allocated to eye health?
Data on eye health expenditure is highly variable and many countries do not report it. Among countries who do, eye health expenditure ranges from 1.5% to 2.7% of total health expenditure.
The trend data on eye health expenditure has been mixed – the proportion of eye health expenditure to total eye health expenditure has decreased for two out of four countries but remained stable for the remaining two countries.
Most countries report some measure of eye health expenditure, although it is often only available for a subset of the health system or of the country.
What is the relationship between countries’ level of expenditure on eye health and prevention and vision outcomes achieved?The relationship between eye health expenditure and vision outcomes is complex, and has many influencing factors. Although the relationship is difficult to clearly discern, it would seem that as prevalence of sight loss increases, so does the share of health expenditure allocated to eye health. This points to a higher level of investment prioritization around eye health by countries in response to greater eye health need.
Where is targeted expenditure required to improve eye health systems and outcomes?
Information: Countries allocate varied levels of investment into the collection, management and reporting of eye health expenditure and outcomes data.
Leadership: Many countries lack a comprehensive and overarching national plan needed to elevate eye health in strategic decision-making.
Workforce: The size and distribution of the eye care workforce is crucial in meeting need and ensuring access to care, however many countries experience eye care workforce gaps.
Services: Countries tend to subsidize eye health treatments more so than early intervention or preventative care. This could potentially lead to eye diseases being treated only once they have progressed
6. What are the top four recommendations or calls to action that have emerged from this report?
Collect more comprehensive data: Funding to improve national data collection around eye health prevalence, drivers, outputs and outcomes will support policymakers to understand eye health need and inform policy decisions.
Plan and prioritize eye health: Funding to develop a strategic eye health plan will help to elevate the vision, policy directions and strategies around eye health and bring together key factors.
Improve workforce supply: Dedicated programmes to develop and train a larger and more equitably-distributed eye health workforce will open access for all and prevent unmet need.
Leverage preventative care: Investment in preventative and early intervention eye care services will promote better eye health outcomes and reduce system costs
7. What are the key research gaps and priorities in eye health financing and outcomes, and how can further research and evidence generation contribute to improved policies and practices?
This study has robustly considered the existing data landscape to answer the research questions.
However, there are certain considerations to note regarding the data sources and methodology used in this study, which are outlined below:
Limited eye health expenditure data: One of the primary objectives of this study was to understand the magnitude of spending on eye health and if possible, any further granular information on spending in this health discipline. However, data on eye health expenditure is highly variable and many official sources across countries do not report this data. As such, any conclusions/findings observed for eye health expenditure should be interpreted with these caveats in mind and considered to be conservative.
Varying availability of data: There exists a varying availability of data to inform each component of the eye health system for each country. Where possible, high quality and reputable sources from official sources (e.g., government agencies, multilateral bodies) were included in this analysis. In some cases where high quality and reputable sources were not publicly available to inform key findings for specific countries, these countries have been omitted from that particular analysis. Because of this, any country comparisons should be interpreted with this limitation in mind, particularly in figures where there is a small sample size.
Varying quality of data: Data quality varies between countries including government, non-for-profit, peer-review literature and grey literature. Where possible, reputable primary sources (such as those published by the nation’s health body/government agencies) were used in the first instance for any analysis. In some countries, sources published by non for- profit/non-government organizations were considered for analysis as these organizations are primarily responsible for the delivery of eye care services in the country. The quality of the data was determined on a case-by-case basis. Because of this, any country comparisons should be interpreted with this limitation in mind.
Limitation of establishing a causal relationship: Given the limited number of data points in the analysis, it is difficult to draw a conclusion relating to the relationship between eye health expenditure and eye health outcomes. Further, any associations observed in the analysis may be due to other factors influencing the variables of interest.
Limitation in search strategies conducted in English: For countries in which the primary language was not English, Google Translate was used to determine country’s national language equivalent terminology, and search strategies were conducted using the translated words/phrases. Whilst a thorough and comprehensive approach to the data scan/ review was undertaken throughout this study, it may be likely that given language barriers some sources were missed from the research.