Vision and Eye Care Costs in the United States
The rising costs of health care in the United States is a significant and complex policy issue with multiple layers of consideration for policymakers.
- Individuals: Cost is often the primary barrier to care that can help prevent and treat chronic illness, including blinding eye diseases.
- Communities: Lack of public awareness about risk factors for eye disease, health promotion efforts that exclude vision and eye health where it naturally belongs (such as in chronic disease prevention and aging health), or public policies that are misaligned with goals for a broader population compound costs over time.
- Systems: Lack of adequate disease surveillance, variations in data collection methods, and few to no measures of accountability related to vision health, vision impairment, and eye disease make it difficult to track and measure progress, close gaps in access, and achieve equity.
According to national forecasts, the national cost of vision problems, including private and public payments for medical care, long-term care, patients’ out-of-pocket costs, direct and indirect costs, and lost productivity and consequential lost tax revenue amounted to $172 billion in 2020. Expenditures nationally are projected to increase to $385 billion by 2032—which is in just 10 years and timed right as the final ranks of the baby boomer generation become Medicare-eligible. By 2050, just as millennials are entering into retirement and becoming Medicare-eligible, national expenditures on vision problems are expected to top $717 billion. Vision problems are expensive to address, but even more expensive the longer our nation goes without addressing them.
Yet, despite the tremendous cost of vision problems, for every $28,923 that our nation spends addressing vision problems, only a single federal dollar is invested annually toward early detection and prevention programs at the Centers for Disease Control and Prevention and toward innovation and research at the National Eye Institute.
Vision impairment and eye disease often contribute to debilitating, costly, and chronic conditions, including: diabetes, injuries and death related to falling, stroke, depression and social isolation, cognitive decline, lack of mobility, and need for long-term care. In addition, studies have found that patients with vision loss experienced longer hospital stays and higher readmission rates, resulting in $500 million in excess costs. Nationally, cost of care is driven by a number of vision-related factors, including our aging population, changing demographics, and the increasing prevalence of chronic diseases. It has yet to be seen if or how the COVID-19 pandemic has exacerbated these trends for the long-term as many people forwent preventive eye care or primary care.
National expenditure on health care is a major theme in policy, particularly because health outcomes are not improving as a result of high national spending. Numerous policy proposals include improving quality of care, reducing barriers for market access of generic and biosimilar products, improving transparency of prices to achieve health literacy and consumer engagement, and creating value-based incentives on payers and providers.
Prevent Blindness advocates for policies that promote access to health care for patients as well as coverage options that allow patients to prioritize their vision health and eye care as a part of their overall health and well-being. We encourage policymakers to consider vision and eye health as part of overall health and well-being. Prevent Blindness reiterates that vision health is an essential contributor to overall health and well-being, and therefore should be an aspect, not a supplement, of health care coverage and approaches to ensuring basic health and wellness for all Americans.
Affordability and Accessibility of Innovative Drugs, Treatments, and Care
Affordable and accessible drugs and treatments are a vital component to a patient’s treatment plan to stop eye disease from progressing. Increasingly, drugs and treatments are becoming inaccessible to patients who may not have adequate coverage, cannot afford their treatments for chronic conditions, or may have difficulty accessing specialty eye care due to lack of transportation or being located in a health care shortage area. Opportunities to address cost, accessibility, and affordability are often missed as they are issues that are considered interchangeable or inextricably linked.
- Cost of Care: Cost of care to an individual is the amount of resources (i.e., financially, emotionally, professionally, or personally) that one can assume to expend to receive vision and eye care and to maintain their vision and eye health over the course of a lifetime. Cost of care may not be directly used on care. For example, taking time off of work, costs associated with transportation to an eye care provider, or resources expended on caregiving or assistance may add to a patient’s cost. Cost of care to a system may come in the form of direct costs (resources expended to provide care) or indirect costs (costs related to doing nothing or letting a problem go unaddressed due to a lack of an adequate, appropriate, or appealing solution).
- Affordability: Affordability is relative to a patient given how much of their own personal resources they are able to expend in receipt of vision and eye care. If a patient cannot afford treatment, the treatment becomes inaccessible to them. What one patient may consider to be affordable may not be affordable to another patient. Additionally, a patient may not be able to afford inaction when it comes to treating their vision and eye health as a result of potential limitation on professional opportunities, loss of income, or impact on overall health and well-being due to inaction. Policy solutions to address affordability must balance both the costs of accessing care and the costs of not accessing care.
- Accessibility: Accessibility can also be relative when considering the number of additional barriers that patients may face when seeking care, and not all barriers to care are the same for every patient. Access to care may depend on one’s ability to acquire transportation or the technology needed to access in-network care, including treatment, therapy, or rehabilitative services. Patients who may not understand how their eye care needs will be balanced against coverage policies may be deterred from seeking eye care altogether, thus furthering their risk for permanent vision loss. Lack of transparency in coverage policies may present a barrier in accessibility if they are overwhelming and confusing for patients, who may be more than likely to forgo care or put it off. A patient’s health literacy, culture, and socioeconomic status can also impact access to care and ability to prioritize vision and eye health among other costly and burdensome conditions. Individuals may also lack access to care if they do not have information about risk factors for eye disease like family history or behaviors such as smoking, or if basic health and wellness efforts exclude vision and eye health information.
All of these considerations are important for patients to understand because vision loss and eye disease are not acute conditions—they are chronic, and require treatment over the course of one’s lifetime from onset of the condition. Affordability and accessibility of care is an issue that is not specific to vision and eye care, and requires significant engagement with coalitions and other patient groups to formulate policies that will address these multi-faceted issues to ensure patients can access high-quality eye care.
