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Table 4 Quotations ‘Unclear returns on investments’

From: Why a successful task substitution in glaucoma care could not be transferred from a hospital setting to a primary care setting: a qualitative study

Stakeholder Quotation
Glaucoma Specialists:  
· I: But it is getting busier with glaucoma patients, and you cannot discharge everyone. R: That's why we created this system, the GFU. I: Do you think that is enough? R: I think so. (Respondent 6)
· If the pressure, the number of patients at the clinic increases, and we have to announce waiting lists again or limit the number of patients at some point, then it will not be beneficial to the quality of care. Then we'll have to do something like that [task substitution], we'll have to go down that road. (Respondent 8)
REH Management:  
· What we do is, we move the chronic patients. Those patients are not financially attractive, not for the partnership either. So to make it financially attractive, we need to see new patients, we must get referrals. (Respondent 1)
· Primary care optometrists only send 1% of our referrals. So we need to arrange the other referral channels. (Respondent 3)
Primary Care Optometrists:  
· But when an optical chain joins, it makes us less unique. And as an independent optical shop, we take optometry very seriously. (Respondent 16)
· Yes, there are customers who come to our shop, even if I do not know them personally… I have not seen them before, but they ask during their visit to the REH where they can buy spectacles, etc. Then they are referred to me, which is really great. (Respondent 16)
· I: As regards the fact that you are part of the Eye Care Network, do you use it, put a sign on the door: ‘Optician, member of the Eye Care Network’? R: Um, good question. Hardly. I: Why not use it? R: Because it has no effect. I: How do you deduce that? R: Instinctive, advertising is purely instinctive. (Respondent 18)
· If you ask me what I think needs to be done, then I think health care insurers are keeping out of the way and do not take enough action in this matter. I think that when it comes to eye care, the health care insurers should accept their responsibility. (Respondent 18)
Dutch Healthcare Authority / Health care insurers:  
· When it comes under the B segment (tariff becomes negotiable) the health care insurer will say: we no longer pay for the part of the DBC delivered by primary care optometrists, because we are already paying those optometrists directly. That is a possibility. Then the Dutch Healthcare Authority does not have to set a price. (The Dutch Healthcare Authority, respondent 27)
· If the reason for your question is: would we insurers be prepared to contract an optometrist, to agree on a tariff and let him be responsible for this care; that is something I would be prepared to consider. But on the condition that the quality of care is guaranteed, that the Health Care Inspectorate is confident about it, and above all that the referring glaucoma specialists have confidence in it. (Health care insurer, respondent 25)
· I think it is a bit more reassuring when you stay under your doctor’s care, of course. A specialist is probably a bit more knowledgeable. You're so used to it. (Respondent 24)
· In some ways, care by a local optometrist might be nicer. The ophthalmologist with his experience and knowledge might see certain things very quickly, though. But I have the impression that at the GFU they have a bit more time for you, they want to know things exactly and are more precise than the doctor.
  But still, if I have the choice between one and the other and they are both of good quality, then I would choose the one that doesn’t cost me anything. (Respondent 23)