If you need genital reconstruction or other transition and affirmation surgeries, you may be eligible to have them covered by public funding. This funding is known as the Special High Cost Treatment Pool, which needs to be applied for by your specialist (such as an endocrinologist) on a case by case basis.
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
- complex cases
Who can apply?
Applications will only be accepted from DHB specialists supported by the responsible DHB manager whose name will be on the contract once application is approved, along with supporting documentation and recommendations for treatment
Eligibility and criteria:
Access to the Special High Cost Treatment Pool will be determined by the Senior Advisor, 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 Overseas
- The treatment being sought must not be available in New Zealand
- 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.
Filling in the application form
Bear the above objectives in mind when answering the following ‘Clinical Details’ questions, below in blue. 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.
This application is for
eg Medical treatment overseas, 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 MtF transgender. Awareness of female gender (with dysphoria) since childhood. Seen psychologist and endo and began HRT 2014. Diagnosed with gender dysphoria by psychiatrist 2015, recommended for surgery.
Where is the treatment currently available – NZ or overseas?
There are currently no NZ specialists
Your chosen provider’s details go here
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
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”
It is not usually possible to receive quotes on letterhead unless a consultation has taken place, but as this is overseas it’s not often possible. Figures for vaginoplasty surgery are around $30,000NZD in Thailand
The Ministry of Health resource pages
Top 10 Frequently Asked Questions
Q: How many people are currently on the waiting list?
A: Over 80, which means around a 40 year waiting time once on the waiting list.
Q: Why only 80 in the whole country?
A: One major reason is that it is very hard to find information about how to get on the list. Another reason is that many medical professionals have been reluctant to put people on the list, due to the anticipated length of the waiting time. Many trans people also do not see a point in applying to get put on the list, because of the waiting time.
Q: How many patients receive care (surgery) via the list each year?
A: The funding is allocated separately for transmasculine and transfeminine people, with the government funding three male-to-female surgeries and one female-to-male every two years. Hence the 40 year wait.
Q: Why are so few people able to access this essential healthcare?
A: It’s about funding allocation. One aspect is that the number of patients on the waiting list is used to measure the need, which in turn influences how much funding is allocated. Historically it has been exceptionally difficult to find information or get onto the waiting list, so the waiting list does not reflect the need.
Q: Are there surgeons in New Zealand who perform GRS?
A: There has been one surgeon performing bottom surgeries for trans women in New Zealand, however he retired in recent years and was unable, despite ongoing effort, to find somone to replace him.
There are have been, and continue to be, no surgeons in Aotearoa who perform GRS for trans men.
Currently no GRS is being performed in New Zealand
Q: Where have trans men been getting GRS?
A: They have been sent overseas
Q: Why have trans women not been sent overseas?
A: Legally, sending patients overseas on public funding is not allowed if the surgery could, in theory, be performed in New Zealand
Q: Now that no surgeries are available in Aotearoa, will trans women be able to go overseas and choose their surgeon too?
A: We hope so. The Ministry of Health is anticipating that state funded surgeries will begin in 2016 – 2017. Whether this will be in Aotearoa or overseas remains to be seen.
Q: If surgery in New Zealand cost $150,000 but surgery in Thailand costs $30,000 does that mean 5 x the number of surgeries will be carried out each year?
A: We certainly hope so, and are advocating for this.
Q: How can I help to change this situation?
A: If every trans person who wants or needs surgery was able to go on the High Cost Treatment Pool waiting list, we would have solid numbers to show the need, and request funding be allocated to meet the need.
Gender Minorities Aotearoa encourages all who want surgery to research their options, talk with surgeons, and apply to be put on the waiting list for High Cost Treatment Pool funding.
There are resources regarding surgery types and lists of approved surgeons here.
You can also write letters to newspapers, write opinion pieces and send them to online news publishers, talk with friends and whanau, write or talk to your local MP, and you can probably think of even more. For information on how to write great letters to editors and send effective submissions to parliament, check out our advocacy guide here.
Together, we will create the future.
© Gender Minorities Aotearoa 2016