Female Sterillisation: Reversal: 'User Pays' Charge: Proposed Introduction

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A decision made 24 April 2012:

Decision Reference: MD-HSS-2012-0011
Decision Summary Title :	Introduce charges for reversal of female sterilisation		Date of Decision Summary:	20th April 2012
Decision Summary Author:	Director of Operations		Decision Summary: Public or Exempt? (State clauses from Code of Practice booklet)	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:
Written Report Title :	Introduce charges for reversal of female sterilisation		Date of Written Report:	18th April 2012
Written Report Author:	Director of Operations		Written Report : Public or Exempt? (State clauses from Code of Practice booklet)	Public
Subject: Reversal of female sterilisation
Decision(s): The Minister for Health and Social Services Department has decided to seek approval from the Minister for Treasury and Resources to increase the current charge associated with female sterilisation in order to enable full cost recovery. This increase is in excess of the 2.5% and RPI.
Reason(s) for Decision: The existing charge, which has not been increased for over 7 years falls short of cost recovery for this non-essential procedure. The Minister approves the proposed increased in charge in order to fulfil the “user pays” principle in relation to this non-essential procedure.
Resource Implications: The proposed new charge will enable HSSD to recover costs associated with this non-essential procedure.
Action required: To seek approval from the Minister of Treasury and Resources Director of Operations to introduce charges
Signature:		Position: Minister for Health and Social Services
Date Signed:		Date of Decision (If different from Date Signed):

Female Sterillisation: Reversal: 'User Pays' Charge: Proposed Introduction

Proposed Charge for Reversal of Female Sterilisation Surgery – Briefing Paper

Purpose

The Minister for Health and Social Services has agreed in principle to the proposed charge to be made to women who request the procedure of Reversal of Sterilisation.

Background

At present, Health and Social Services (H&SS) charge the service user for male and female Sterilisation, Termination of Pregnancy, and Fertility treatment, however there has never been a charge for Reversal of female Sterilisation.

Reversal of female Sterilisation – Proposed Charge

The National Health Service provides this procedure at a cost to the service user of £2,844.00.

If this service is provided privately the current charge levied by HSSD would be £1,356.00. These charges are currently under review, and do not include pre and post surgery outpatient appointments, Theatre equipment and supplies, or Semen Analysis. Insurance companies do not cover this charge.

The table below provides a financial breakdown of the costs of this service to Jersey H&SS.

Initial outpatient appointment	£54.00
Blood Test	£51.78
Semen Analysis	£105.24
Laparoscopy (In Day Surgery Unit)	£419.53
Follow up appointment	£52.63
Surgery (Main Theatre)	£1086.51
Recovery on Rayner ward	£238.55
Follow up	£52.63
Total	£2,178.00

The proposed charge by H&SS for Reversal of female Sterilisation is therefore £2,178 Yearly increase should occur in line with inflation.

Scope

Reversal of female Sterilisation is a surgical procedure that involves the reconstruction of fallopian tubes in women. This is carried out under General Anaesthetic and requires an inpatient stay in hospital. It is considered a low priority procedure. H&Ss may fund in exceptional circumstances;

 If the patient had overriding reasons to have the Sterilisation at the time it was carried out, such that long term reproduction wishes were not the primary consideration.

 If there has been a change in the patient’s circumstances that could not reasonably been considered at the time of the primary procedure (loss of child under the age of 16)

Estimated Financial Impact of Charges

The aim is to introduce a charge to service users, reflecting the cost to H&SS, within the scope of user pays charges. The financial objective for introducing this charge is to ensure the cost recovery of service provision to non-exempt service users.

H&SS provided this service to 3 patients in 2008, 1 in 2009 and 1 in 2010. These were within the public service, with none being undertaken as Private Patients. With such a small amount of patients requesting the service, it is unlikely that demand will reduce as a result of the proposed charge. It is important to note that this charge will fall below the current charge of the National Health Service, so it is unlikely that the service user will choose to undergo the procedure outside Jersey.

Additional Information

H&SS policy for Reversal of female Sterilisation has been developed and is available on HSSNet.

Patient Information Leaflets have been produced and are in use in outpatient Gynaecology clinics.

Recommendation

The proposed charge for Reversal of female Sterilisation should be introduced under the scope of user pays charges, to meet HSS cost of providing the service.

Angela Body

Director of Operations