User Pays Charges - pathology

STATES OF JERSEY

USER PAYS' CHARGES: PATHOLOGY

Lodged au Greffe on 27th October 2009 by the Minister for Health and Social Services

STATES GREFFE

2009   Price code: B  P.185

PROPOSITION

THE STATES are asked to decide whether they are of opinion

1. to refer to their Act dated 24th June 2003 in which they agreed that no new  user  pays'  charges  should  be  introduced  without  the  prior approval of the States; and
2. to  approve  the  introduction  of  specified  charges  for  General Practitioner test requests for specified services in Haematology and Clinical Chemistry as set out in the Appendix to the Report of the Minister for Health and Social Services dated 27th October 2009.

MINISTER FOR HEALTH AND SOCIAL SERVICES

REPORT

Introduction

The  Health  and  Social  Services  Department  is  seeking  to  introduce  a  charge  for specific  Haematology  and  Clinical  Chemistry  services  provided  to  General Practitioners, with effect 1st January 2010.

The  introduction of  the proposed  charge  will  aid the  Health  and  Social  Services Department  to  address  the  financial  impact  of  primary  care  activity  on  Clinical Chemistry and Haematology and remain within its departmental cash limit for 2010 (as approved by the States in September 2009).

The Social Security Department has agreed to introduce an additional benefit, funded through the Health Insurance Fund to match the cost of this charge. This ensures that there will be no cost to the patient as a result of the new charge.

Proposal

It is proposed that the £10 charge will be based on a laboratory episode which is defined as a request form for Haematology or Clinical Chemistry services (irrespective of the number of individual tests within the request form) from a General Practitioner (G.P.) providing services which fall within the remit of the Health Insurance (Jersey) Law 1967.

In broad terms the affected services cover the investigation of symptoms, the care of existing medical conditions in primary care lead by a General Practitioner (G.P.), and the testing of well individuals according to screening programmes approved by the Royal College of General Practitioners.

It should be noted that –

• a  consultation  between  a  G.P.  and  patient  which  requires  laboratory investigation  usually  generates  an  episode  for  Haematology  and  one  for Clinical Chemistry; and

• under this proposal, the charge of £10 per episode raised only covers those direct costs associated with G.P. test requests in Haematology and Clinical Chemistry.

Exemptions

This proposal does not supersede or affect the current raising of charges made by the Health and Social Services Department to G.P.s in respect of tests for commercial BUPA style health screening of well individuals (e.g. for local finance companies etc.).

Administrative arrangements

In order to minimise the administration required to manage this charge it is proposed to introduce the following arrangement –

• the patient will sign a declaration at the time of the G.P. consultation, agreeing that the benefit(s) be assigned to the Health and Social Services Department;

• the  Health  and  Social  Services  Department  will  submit  a  list  of  patients receiving tests to the Social Security Department;

• the Social Security Department will check that the patient is eligible for the benefit(s)  and  make  payments  directly  to  the  Health  and  Social  Services Department;

• on a quarterly basis, the Health and Social Services Department will reconcile its activity data against the payments made by the Social Security Department and raise any issues of concern with that Department with a view to ensure that the scheme is recovering its agreed costs;

• the Social Security Department will undertake periodic audits of the benefit claim process.

Financial and manpower implications

In broad terms the impact of the proposal is as follows –

• the generation of approximately £750,000 per annum income in 2010 for Health and Social Services;

• no additional manpower or finance is required to administer the proposed scheme by Health and Social Services and the Social Security Department;

• there will be no detriment to patients or G.P.s. Ministerial Decision

Please  refer  to  the  Appendix  which  sets  out  the  relevant  part  of  the  Ministerial Decision that supports this report

Recommendation

The recommendation of this report is to introduce a £10 per episode user charge to General Practitioners in respect of specified Haematology and Clinical Chemistry services.

APPENDIX

Health and Social Services Department Proposed Introduction of Specific Pathology Charges Ministerial Decision – Reference MD-HSS-2009-0055

Subject: Proposed introduction of charges for General Practitioner test requests for specified services in Haematology and Clinical Chemistry.

Decision(s):  Subject  to  the  approval  of  the  States  and  the  support  of  the  Social Security Department, it is proposed to introduce a charge of £10/episode (i.e. request form) for General Practitioner test requests for specified services in Haematology and Clinical Chemistry with effect 1st January 2010.

Reason(s) for Decision: The introduction of the proposed charge will aid the Health and  Social  Services  Department  to  address  the  financial  impact  of  primary  care activity on Haematology and Clinical Chemistry and remain within its departmental cash limit for 2010 (as approved by the States in September 2009).

Resource Implications: The introduction of the proposed charge will be met from the existing Health Insurance Fund and is estimated to be approximately £750,000/annum in 2010.

No additional manpower or finance is required to administer the proposed scheme by Health and Social Services and the Social Security Department.