Contraceptive Clinics: Fees Increase

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A decision made 9 December 2011:

Decision Reference: MD-HSS-2011-0056
Decision Summary Title	Increase in Community Contraceptive Services Fees		Date of Decision Summary:	9 December 2011
Decision Summary Author:	Head of Health Improvement		Decision Summary: Public or Exempt? (State clauses from Code of Practice booklet)	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:	Andrew Heaven Sarah Howard
Written Report Title :	Proposed Increase in Community Contraceptive Services Fees		Date of Written Report:	28 November 2011
Written Report Author:	Andrew Heaven (Public Health Department)		Written Report : Public or Exempt? (State clauses from Code of Practice booklet)	Public
Subject: Charges for Community Contraceptive Clinics.
Decision(s): The Minister for Health and Social Services has considered an increase in the proposed fees for the Community Contraception Clinics and decided she would wish to increase the various fees as set out in the report.
Reason(s) for Decision: The proposed increase in service charges will enable the Community Contraceptive Clinics to continue to deliver its service and remain within existing budget limits.
Resource Implications: The income gained from the increased charges will meet the staff and product costs estimated to continue to provide exemptions for Under 23 year olds. Furthermore an annual review of Community Contraception Fees will be undertaken.
Action required: Revised fees will be introduced from the 1st of January 2012
Signature:		Position: Minister for Health and Social Services
Date Signed:		Date of Decision (If different from Date Signed):

Contraceptive Clinics: Fees Increase

Proposed Increase in Community Contraceptive Services Fees – Briefing Paper

Purpose

The Minister for Health and Social Services has agreed in principle to the proposed increase in charges made to women who attend the community contraceptive service.

Jersey Sexual Health Strategy

One of the key priorities within the Jersey Sexual Health Strategy (2007) is to ‘review and improve the overall provision of contraceptive services.’ The strategy aims to reduce unintended pregnancies and sexually transmitted infections (STIs) by providing accessible services responding to local needs. The community contraceptive service continues to play a key role in ensuring the strategy is successful and will be an important source of expertise when considering enhanced sexual health services in general practice.

Community Contraceptive Services – Revised Charges

The service continues to experience a high demand and needs to respond accordingly whilst remaining within the existing budget. There has been no a significant review of fees and exemptions since 2005. The last rise in charges made for oral contraception products was in 2003. At that time the uplift between the product cost and price charged to the patient was 20%.

The table below, describes the three proposed changes to the charging structure and fees charged for using this service. The increased revenue received will fund the increased running costs of the clinics. Future fees for service will be revised annually.

The timescale for implementing the new charges is the first quarter in 2012 and will be revised annually in accordance with other Public Health Service charges.

Table 1: Summary of Proposed increased charges

Proposed Change

Rationale

Revise the number of exemptions for attendance and prescribing fees which will now apply only to women under 23 years or students in full time education.

Targeting of subsidised service toward younger women who may still be establishing a contraceptive method which is most appropriate to them and their social circumstances.

Increase attendance fee from £10.00 to £15.00. The revised fee will also be applied to Well Woman Clinic appointments.

The increased income will be used to meet the increasing cost of the clinics and other materials such as patient information.

Increase the cost to the client of contraceptive products from an average of 20% to 50% difference across the range of contraceptive products offered

Income received from charges will allow a wide range of contraceptive choices to continue to be offered (including newer contraceptives).

Reduce the difference in product prices between contraceptive service and community pharmacists.

Estimated Financial Impact of Changes

The financial objective for increasing charges and reducing the exemption criteria is to ensure the cost recovery of service provision to non-exempt clients.

Charges for non-exempt clients have not been increased since 2003. At this time charges were set at a nominal level and effectively provided a subsidised service, therefore in order to achieve full cost recovery, a substantial increase is now required.

Compound inflationary increases have been applied to the 2003 charge and on average account for over half of the fee increases.

Clients attending for the most frequent appointments & products issued will experience approximately £5.00 - £8.00 increase in the total charge for the service they receive. The greatest increase, but far less common, will be experienced where the purchase cost of the product is significantly higher and requires fitting (e.g. coils and implants), this increase will be up to 50% more than the current charge, however the product is effective for a significantly longer period of time therefore requires less appointments over the long term.

It is important to note that the increased charges fall well below those of the private sector. It is therefore unlikely that the service would see any significant reduction in activity as a result of the changes proposed. Furthermore, the net effect of these increased charges is the continued provision of a contraceptive service which is able to offer a targeted subsidy.

Recommendation

The proposed changes to the charges for the community contraceptive services will enable the service to meet the high demand and cost of providing the service.

These proposed charges will replace the existing Ministerial Decision (HSS 2009 MD 0050) which referred to revised fees based on inflation only.

Andrew Heaven

Head of Health Improvement

(Sexual Health Strategy Lead)

28 November 2011