If you need Genital Reconstruction Surgeries (GRS), you may be eligible to have them covered by public funding. This funding is known as the Special High Cost Treatment Pool, which is managed by the Ministry of Health (MoH).
In a nutshall: currently you must get your GP to refer you to a DHB specialist (such as an endocrinologist or a sexual health doctor), or take yourself to a sexual health doctor. Only the DHB specialist can refer you at themoment, though this will soon change to a GP initiated model. In Wellington, a GP initiated model is already in use, which only requires a sign off from a DHB specialist.
If you have previously had a readiness assessment from a clinical psychologist in order to begin hormone replacement therapy (HRT), you do not need another assessment before being referred to the HCTP list, as the wait time is longer than one year, so you will need a new assessment when you reach the top of the waiting list.
Situation as at July 2019
We are proud of the recent gains made
- a surgeon in NZ – Dr Rita Yang, who performs vaginoplasty, metoidioplasty, and phalloplasty (as well as top surgeries privately)
- lifting the cap on the maximum number of GR surgeries per year
- $3million allocated for GRS from the 2019 government budget (for the next 3 years)
- changing the pathway to a GP initiated one, to improve access to the waiting list, particularly for those in small towns and rural areas
However, this leaves us with a current waiting time on the HCTP list of around 12 years. This breaks down as 160 patients on the waiting list, at aprox 13 surgeries per year.
NOT GOOD ENOUGH. Let’s make sure we keep advocating for change. We encourage all who want GRS to apply and get on the list, and to make noise – write letters to your local MP, arrange to take a friend and meet with them and tell them why it’s important, don’t take no for an answer. Note: it’s MPs, not the MoH, who decide whether to finance surgeries.
The purpose of Special High Cost Treatment Pool is to
- ensure equitable access throughout the country to Special High Cost Treatments
- manage the financial risk for certain highly specialised procedures which pose a risk due to their unknown or fluctuating costs
- promote the use of cost effective procedures in the public health care system
Special High Cost Treatments include the following
- medical treatment overseas
- treatment not currently available within the public health system (GRS)
- complex cases
Who can apply?
Applications will now be accepted from any GP in NZ, with sign off from a DHB specialist who is supported by the responsible DHB manager/senior medical officer, whose name will be on the contract once application is approved.
Eligibility and criteria:
Access to the Special High Cost Treatment Pool will be determined by the Senior Advisor at the Ministry of Health (MoH), and a panel of relevant Ministry officials in the context of the Ministry’s statutory objectives and functions.
In reaching decisions on access to the Treatment Pool, the Senior Advisor and panel will have regard to the eligibility criteria below, and to the applicant’s individual circumstances.
Special High Cost Treatment
- GRS is now available in NZ, and is accepted as a standard treatment for gender incongruence (soon to replace ”gender dysphoria”)
- The treatment has proven efficacy when applied in regular practice
- The chosen treatment is cost effective which means that:
1. the expected long term savings to the health care system outweigh the initial costs of the treatment; and/or
2. the dollar cost for the expected benefit are acceptable when evaluated against other MoH priorities
3. Failure to receive the treatment could result in serious irreversible deterioration of the patient’s condition or an inability to recover lost function, or significant impairment to normal development of a child; or
4. Failure to receive the treatment could deny an adult with a lifelong disability access to treatment which would lead to a marked improvement in their quality of life.
How to get on the list
To get on the High Cost Treatment Pool waiting list for public funded bottom surgery you need your GP to refer you, and your GP needs to get a DHB specialist to also sign their name to it.
Two specialists who could sign off are a sexual health doctor, or an endocrinologist. There may also be others – they simply have to be ”a DHB specialist” to the best of our knowledge.
Here is the form that you and your referring specialist need to fill out, and it includes where to send it.
Filling in the application form
Bear the above objectives in mind when answering the following ‘Clinical Details’ questions. Examples have been added for demonstration only, you will need to give your own answers.
We recommend you write down your answers, and take them with you when you go to see your specialist.
Notes on clinical details which may be included
This application is for
eg Medical treatment not currently available within the public health system (as per above info)
Degree of urgency
eg As soon as surgery is possible
Details of diagnosis, history, and treatment required
eg Gender incongruence. MtF transgender. Awareness of female gender (with dysphoria) since childhood. Seen psychologist and endo and began HRT 2014. Recommended for surgery.
Where is the treatment currently available – NZ or overseas?
eg Dr Rita Yang, NZ.
Reason/s for referral to chosen provider
You have researched options, tell them that and make your case
You have one paragraph tops, around 30 – 60 words
Eg Dr Yang is in NZ, she can perform the surgery I need.
What evidence is there that this treatment is effective (please attach evidence in the form of journal articles etc. the articles must be provided in full either in herd or electronic copy)
eg This is now a standard vaginoplasty, practised around the globe by dozens of surgeons. Evidence is not needed as this is now a common practise
What would be the effect of receiving this treatment
Make your case here, eg alleviate your lifelong suffering and allow you to carry out simple tasks like using the bathroom. Make you comfortable to wear your clothing, be intimate with partners, go swimming, etc.
You have one paragraph, around 30 – 60 words max
What would be the effect of not receiving this treatment
Make your case here, eg trauma and dysphoria every day, bladder infections due to not using public toilets, long term depression and suicidality, etc.
You have one paragraph, around 30 – 60 words max
This patient has the additional current/past medical conditions
Estimated full cost of all components of treatment (GST exclusive) in NZD (estimate required on provider letterhead)
eg ”Costs will be defined accurately when application is accepted”
The Ministry of Health resource pages
The current situation at 2018