Paediatric Ophthalmological Care in Large Ophthalmology Centres in Comparison to the Entire Specialist Group.

Abstract

Background: Paediatric ophthalmological care is suffering from a thinning care network. Two (of several) possible causes are the increasing number of new forms of organisation (large contract medical facilities in terms of number of patients, doctors and locations) and medical care centres (MVZ) in non-physician ownership.

Methods: In a network of large ophthalmological care facilities, paediatric ophthalmological care activities per provider were surveyed for 2019 for all providers according to the proportion of the number of cases and structural characteristics (number of locations with orthoptists and sites with paediatric surgery), evaluated overall and in the subgroups according to ownership (non-physician or physician ownership) and compared with specialist group-related comparative data.

Results: With the one exception of a physician ownership provider, all providers (total n = 15, 12 of which were physician-owned) treated children < 6 years. In 2019, a total of 90,461 statutory health insurance (SHI) cases of children < 6 years were treated (9.3%of all SHI cases in children < 6 years in Germany). In the entire cohort, their share of all SHI cases was 3.7% (physician ownership: 4.8%, non-physician ownership: 3.2%). For the specialist group of all ophthalmologists in Germany, the average was 3.2% (difference not significant). Orthoptists worked at a total of 98 locations (58 physician ownership, 40 non-physician ownership, difference significant [p = 0.03]). Outpatient and inpatient paediatric surgery were offered by all non-physician owned providers and some physician owned providers.

Conclusions: In this first large study on paediatric ophthalmic care in relation to the provider, the contribution of the newer types of organisation was evaluated. In comparison to traditional practices, there was no systematically different orientation - either for the whole study group or for any type of provider, as based on the relative proportion of children with SHI insurance or structural indicators (orthoptists or, outpatient or inpatient surgical care).