As of the end of February, thousands of men in Finland were waiting for the sterilisation treatment commonly referred to as a vasectomy through the public health system. In some areas, such as the Pirkanmaa wellbeing services county, the wait for a vasectomy can be around three years.
A vasectomy is a surgical procedure designed to cause permanent infertility. The procedure itself is relatively quick and easy, but urologists believe that other health concerns outweigh sterilisation.
"There is no ethical justification whatsoever for using our scarce resources to perform vasectomies," said Juha Koskimäki, Director of the Pirkanmaa Surgery Department and President of the Finnish Urological Association (FUA).
Koskimäki said that it is a question of prioritisation.
"We have had to reallocate our resources for patient care to treat diseases. We have had to prioritise the treatment of cancer patients in particular," Koskimäki continued.
Ambiguity over the law
The lengthening of vasectomy queues resulted from a dispute over whether sterilisation is covered by the Health Care Act and whether it is a tax-funded health service at all. Under the Health Care Act, there is a treatment time guarantee in which a person should receive a non-urgent treatment they need within six months of being diagnosed.
According to the urologists and the FUA, sterilisation is not covered by the treatment time guarantee. The Ministry of Social Affairs and Health holds a completely different view.
"Vasectomy is covered by the treatment time guarantee," said Tapani Hämäläinen, Medical Counsellor at the Ministry of Social Affairs and Health.
He admitted that the ambiguous situation is due to differences in interpretation of the law.
"There are inaccuracies in the legislation on sterilisation that need to be clarified. Urologists are likely to have picked up on this imprecision," Hämäläinen said.
According to the interpretation of the FUA, vasectomies are not covered by public health services, nor by the guarantee of treatment.
"Vasectomy is not a disease, nor is it a health treatment, but a means of prevention. It is therefore excluded from the scope of the law," said Koskimäki.
Private or public?
Koskimäki also noted that men who want a vasectomy can seek a private procedure at their own expense.
On the public side, the price of a vasectomy is a few hundred euros, while on the private side the price can go up to more than 1,000 euros.
"Contraceptives are usually paid for by the patient, not by society," Koskimäki said.
The health ministry has received inquiries from wellbeing services counties as to whether vasectomies are included in the treatment time guarantee.
"The ministry's interpretation is that the range of services also includes other medical procedures and services offered on social grounds, such as abortions. Sterilisations have been part of the publicly funded range of services for decades. There should be good justification that sterilisations should now be outside the range of services, or the legislation should change," stated the General Secretary of the Finnish Council for Choices in Health Care, Hanna-Mari Jauhonen from the Ministry of Social Affairs and Health.
The Health Care Act obliges wellbeing services counties to organise contraceptive counselling and other services that promote sexual health.
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