Strong decline in female sterilization rates in Norway after the introduction of a new copayment system: a registry based study

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".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.For many Norwegian women seeking contraception, sterilization is no longer an available alternative.A new copayment system for sterilization was introduced in Norway January 1, 2002. Copayment for outpatients increased from 33 euros to 750 euros for women and from 27 euros to 156 euros for men. No copayment is charged from inpatients. This substantial change in copayment for sterilization was part of a revision of the health care system [1]. Norwegian citizens have the right to free medical care within certain limitations. In January 2002, a system was commenced where the right to medical care was divided into three levels, with sterilization in the lowest priority group with corresponding high copayment (50% and 100% of estimated costs for women and men, respectively).The Norwegian Patient Register is an administrative database containing activity data for all public and private hospitals in Norway [2]. Reporting is mandatory and is linked to the re-imbursement system for funding of health services.The sudden change in patient copayment together with the complete record in the Patient Register presented us with a unique opportunity to study th