Comparative analysis of delivery of primary eye care in three European countries

Einleitung/Hintergrund: The organization of primary eye care services in Europe is not uniform. While in some countries primary eye care is exclusively within the scope of practice of ophthalmologists, other systems rely on academically educated optometrists for these services. Daten und Methoden: The central question of this study is, whether costs and outcomes of eye care services differ in countries with different systems of delivery. Having similar populations and economic conditions, but differently organized eye care systems, the countries France, Germany and the UK are exemplarily analyzed as target countries of the project. A criteria-based evaluation of costs and outcomes was conducted. Ergebnisse: The analysis showed that the systems basing on ophthalmologic services (France and Germany) face the same problems concerning age-development of medical specialists accompanied by an increasing demand for primary eye care services. The British optometrists, delivering primary eye care services in the UK, are averagely younger and show a more uniform distribution than the French and German ophthalmologists. At the same time no decrease in quality of services or even a danger for patients was ascertained, when services were delivered by qualified optometrists. Thus the UK system seems to be better prepared for an increased demand. Concerning costs of eye care e.g. sight tests there were no significant difference between the British optometrists compared to the French and German ophthalmologists. Merely the education costs differ between the systems, as British optometrists are educated less extensively than German and French ophthalmologists. Diskussion/Schlussfolgerungen: As at today all three systems are working fine. Albeit the German and French system are facing increases of waiting times for ophthalmologic appointments and regional lacks of medical specialists. The British system is an example for a system basing on lower educated professionals, performing high quality primary eye care services.