Strong decline in female sterilization rates in Norway after the introduction of a new copayment system: a registry based study.
BACKGROUND
January 1, 2002, copayment for outpatient female sterilization in Norwegian public hospitals increased from 33 euro to 750 euro after a revision of the health care system. The aim of the present study was to investigate the effect of the new copayment system on female sterilization epidemiology.


METHODS
We retrieved data on all female sterilizations 1999-2005 (N = 23 1333) from the Norwegian Patient Register, an administrative register to which it is mandatory for all hospitals to report. Sterilizations with diagnostic codes indicative of vaginal delivery, caesarean section, spontaneous abortion, ectopic pregnancy, and termination of pregnancy were analyzed separately. All other sterilizations were defined as "interval sterilization".


RESULTS
An abrupt fall in female sterilization was observed after the raise in copayment. Age-adjusted incidence rates dropped from 6.3-6.8 per 1000 women in 1999-2001 to 2.2-2.3 per 1000 women during 2002-2005. Interval sterilizations dropped to 25% of the previous level after the rise in copayment while sterilizations in conjunction with caesarean section and postpartum sterilization remained constant.


CONCLUSIONS
For many Norwegian women seeking contraception, sterilization is no longer an available alternative.
Bakken
Inger J
IJ
Department of Epidemiology, SINTEF Health Research, N-7465 Trondheim, Norway. inger.bakken@sintef.no
Skjeldestad
Finn E
FE
Schøyen
Unni
U
Husby
Marit G
MG
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D017047:Cost Sharing / Q000331:legislation & jurisprudence*; D016208:Databases, Factual; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000191:economics; D017722:Hospital Charges; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics* / Q000331:legislation & jurisprudence; D009664:Norway; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D012042:Registries; D013245:Sterilization, Reproductive / Q000145:classification / Q000191:economics / Q000706:statistics & numerical data*