Health Services (Fees) Law (1998 Revision) THE HEALTH SERVICES (FEES) LAW (9 OF 1993)

Health Services (Fees) Law (1998 Revision) Supplement No. 8 published with Gazette No. 14 of 7th July, 1998. THE HEALTH SERVICES (FEES) LAW (9 OF 1993) (1998 Revision) Revised under the authority of the Law Revision Law (19 of 1975). Originally enacted- Law 9 of 1993-21st June, 1993 Revised this 16th day of June, 1998. 1 Health Services (Fees) Law (1998 Revision) 2 Health Services (Fees) Law (1998 Revision) HEALTH SERVICES (FEES) LAW (1998 Revision) ARRANGEMENT OF SECTIONS 1. Short title 2. Definitions 3. Fees payable by patients of the health care facilities 4. Residents of Cayman Brac and Little Cayman 5. School children 6. Ante-natal services 7. Contraceptive services 8. Poor persons 9. Free treatment 10. Exemption not to apply in certain circumstances 11. Offence Schedule: Fees 3 Health Services (Fees) Law (1998 Revision) 4 Health Services (Fees) Law (1998 Revision) HEALTH SERVICES (FEES) LAW (1998 Revision) l. This Law may be cited as the Health Services (Fees) Law (1998 Revision). Short title 2. In this Law- D19e9fi7n iRtieovniss ion “Caymanian” means a person possessing Caymanian status for the purpose of the Immigration Law (1997 Revision); “health care facilities” means the George Town Hospital in Grand Cayman, the Faith Hospital in Cayman Brac and any other public health facility or public hospital established or operated in the Islands by the Government. 3. (1) Except as otherwise provided by this Law, the fees specified in the Fees payable by patients Schedule are payable by patients of the health care facilities. of the health care facilities (2) Where a patient is provided with a service specified in Part 2 (Inclusive Fees - Minor and Intermediate Surgical Cases) or Part 3 (Inclusive Fees- Major Cases) of the Schedule the patient will be charged the fee specified in that Part but will otherwise be charged the individual itemised fee or fees specified in Part 1 of the Schedule. 4. (1) Subject to subsection (2), a Caymanian ordinarily resident in Cayman Residents of Cayman Brac or Little Cayman who is a patient at the Faith Hospital in Cayman Brac is Brac and Little Cayman liable to pay fees at fifty percent of the rate specified in the Schedule. (2) Subsection (1) does not apply in respect of a person who is covered by health care insurance which would otherwise cover the whole cost of any service provided at the Faith Hospital. 5. Subject to section 10, fees are not payable in respect of a patient at a health S19ch9o7o Rl ecvhiisldiorenn care facility if the patient is a Caymanian who has not attained the upper limit of school age as defined in the Education Law (1997 Revision). 6. Subject to section 10, fees are not payable for ante-natal services provided at Ante-natal services a health care facility to a Caymanian who is ordinarily resident in the Islands. 7. Subject to section 10, fees are not payable for contraceptive services Contraceptive services including clinics, devices and drugs provided at a health care facility to a Caymanian who is ordinarily resident in the Islands. 5 Health Services (Fees) Law (1998 Revision) 8. Fees payable by a patient at a health care facility may be waived, in whole or Poor persons in part, if the patient satisfies the Government that he is unable to pay all or any part of the fees. Free treatment 9. Subject to section 10, fees are not payable by a patient at a health care facility if the patient presents a card issued or recognised by the Government identifying the patient to be - (a) a public officer or the spouse or a dependent of a public officer (but only to the extent provided in the terms of employment of the public officer); (b) a member of the Veterans Association of the Cayman Islands or the spouse of such a member; (c) a veteran member of the Seamen’s and Veterans’ Association of Cayman Brac or the spouse of such a member; (d) a person receiving a pension from the Government or the spouse of such a person; or (e) a patient who is being investigated or treated for AIDS, tuberculosis or malaria if so certified by the Medical Officer of Health. Exemption not to apply 10. The exemptions from fees provided for by sections 5, 6, 7, 8 and 9(b), (c) in certain circumstances and (e) do not apply in respect of a person who is covered by health care insurance which would otherwise cover those fees. Offence 11. Whoever supplies false or misleading information when applying for an exemption or rebate of fees otherwise payable under this Law is guilty of an offence and liable on conviction to a fine of five thousand dollars or to imprisonment for six months. 6 Health Services (Fees) Law (1998 Revision) SCHEDULE FEES PART I - INDIVIDUAL ITEMISED FEES Section 3 Division 1 - General fees $ 1. Hospitalisation (including room, routine medical and nursing services), per day 200 2. Intensive care - per day 300 3. Use of delivery room - per day 300 4. Maternity hospital care - per day 225 5. Neonatal care - per day 250 6. Operating theatre- major surgery 350 minor surgery 250 7. Anaesthesia- major surgery 200 minor surgery 100 8. Surgeon’s fees- major surgery 350 minor surgery 250 9. Consultation-in-patient physician’s fees 50 10. Hospital clinics-consultation during scheduled hours 25 11. Referral-appointment with specialist 40 12. Emergency room (excluding drugs)- Level 1 60 Level 2 100 Level 3 250 Injection 10 Dressing 10 13. Ambulance services- emergency 100 transfer 75 transport without special assistance 5 per mile 14. Escorting patient to overseas institution Full cost to be paid Division 2 - Administrative Services 15. Medical autopsy and report 700 16. Medical examination report 60 17. Police certificate 10 18. Replacement of registration card 10 7 Health Services (Fees) Law (1998 Revision) Division 3 - Special Services 19. Laboratory service (cid:96) Fees 20. Radiology calculated 21. Pharmacy according 22. Medical supplies to services 23. Physiotherapy provided 24. ECG and interpretation 25 25. Foetal monitoring 30 26. Private duty and special duty nursing Full cost to be paid 27. Renal dialysis- residents 200 visitors 300 Division 4 - Dental Services 28. Consultation 10 29. Full examination 25 30. X-ray- per film 15 31. Extraction - per unit 25 32. Impacted tooth 100 33. Surgical 100 34. General Anaesthetic- major surgery 200 minor surgery 100 35. Prophylaxis 25 36. Periodontal 80 37. Silver filling- small 30 large 50 38. Filling tooth, coloured small 25 large 60 39. Gold filling- 200 per additional surface 45 40. Crowns- gold 200 acrylic 125 41. Root canal therapy 150 42. Dentures- upper or lower, full 180 upper and lower, full 330 partial upper or lower, acrylic 135 to 180 (according to the work performed) Clasp- steel Included in denture costs gold Ditto, plus 8 Health Services (Fees) Law (1998 Revision) cost of gold re-line 60 repair 32 addition 32 43. Pin retention 40 44. Acid etching 25 45. Fissure sealing 55 46. Therapeutic dressing 28 47. Unit of bridgework or single bonded crown 200 48. Treatment of sensitive cementum - per course 35 49. Apicoectomy and retrograde root filling 150 50. Partial chrome-cobalt metal denture 350 51. Pan-oral X-ray 35 Division 5 - Other Services 52. Home physician visit 30 53. District clinic physician visit 15 54. Home nursing visit 10 55. District clinic nursing service 5 Division 6 - Provision of Supplies 56. Provision of drug or medicines or any prosthesis or implants Cost of obtaining and supplying PART 2 - Inclusive Fees-Minor and Intermediate Surgical Cases Notes: (1) The fee for a service specified in this Part covers - (a) the surgeon’s fees; and (b) the health care facility fees for up to six hours after the operation. (2) It does not cover - (a) biopsy charges unless otherwise stated; (b) the cost of any drugs, medicines or any prosthesis or other implant: or (c) the health care facility costs after six hours after the operation which will be charged for at the rate of $25 an hour. 57. Minor Surgical Cases (1) Urethral dilatation 300 (2) Dilatation and curettage 350 (3) Needle biopsy of testes or liver 350 (4) Urethral cystoscopy 350 (5) Oesophagoscopy 350 (6) Bronchoscopy 400 (7) Larynogoscopy 400 (8) Sigmoidoscopy 350 9 Health Services (Fees) Law (1998 Revision) (9) Gastroscopy 450 (10) Colonoscopy 400 (11) Vasectomy 300 (12) Excision of warts- general anaesthetic 250 local anaesthetic 50 to 150 according to the number and size (13) Cauterisation of warts- general anaesthetic 250 local anaesthetic 100 (14) Anal dilatation 200 (15) Excision of small lipoma (up to 3 in number)- general anaesthetic 250 local anaesthetic 150 (16) Excision ptygerium of the eyes- with grafts 250 otherwise 150 (17) Excision chalazin (meibomian cyst) 250 (18) Myringotomy 250 (19) Frenulectomy 150 (20) Dental extractions- general anaesthetic- under 30 minutes 125 30 minutes or over 200 (21) I and D Bartolin’s cyst- without excision of sac 200 with excision of cyst 250 (22) Steinmann’s pinning-anterior tibia- general anaesthetic 150 local anaesthetic 100 (23) Plaster of paris-hand, arm or leg 100 (24) Closed reduction of fractured wrist or ankle with plaster of 250 paris (25) Closed manipulation of dislocated hip or shoulder 350 (26) Epidural- pain therapy (under 2 hours) 150 (27) Release of carpal tunnel syndrome 350 (28) Excision of ganglion 350 (29) Release of Dupuytren’s contracture 350 (30) Bilateral antral sinus washout 300 (31) Adenoidectomy 250 (32) Circumcision- new-born 50 under 12 months 150 over 1 year or over 200 (33) Examination under anaesthesia 200 58. Intermediate Surgical Cases (1) Insertion of shirodkar suture of cervix 350 (2) Excision lipomas (more than 3)- general anaesthetic 300 local anaesthetic 150 (3) Sub-mucous resection of nasal turbinates 350 10 Health Services (Fees) Law (1998 Revision) (4) Tonsillectomy and adenoidectomy 350 (5) Tonsillectomy 300 (6) Iridectomy 250 (7) Correction of ectropian 250 (8) Extraction of cataract 550 (9) Dental fillings: general anaesthetic 30 minutes or under 200 over 30 minutes 350 (10) Excision of breast lump including cost of biopsy 400 (11) Microductectomy of breast 300 (12) Hip spica plaster of paris 200 (13) Debridement of wounds- general anaesthetic- up to one hour 200 each hour thereafter 50 (14) Removal of foreign body from foot or hand 250 (15) Incision of drainage and irrigation of the knee 300 (16) Hydrocelectomy 350 (17) Varicocelectomy 300 (18) Untwisting of torsion testes 350 (19) Orchidopexy- single 350 double 400 (20) Removal of cyst of the epididymis 250 (21) Haemorroidectomy- general anaesthetic 350 local anaesthetic 250 (22) Tubal ligation 400 (23) Supra-pubic cystectomy 300 (24) Amputation of finger or toe 250 (25) Plastic repair of tip of finger or toe 200 (26) Tracheostomy 350 (27) Fistulectomy 400 (28) Skin graft- first hour 300 each hour thereafter 100 (29) Rhinoseptoplasty 400 (30) Removal of foreign body from throat or oesophagus- first hour 400 each hour thereafter 100 (31) Appendectomy 350 (32) Herniotomy (no children) 300 11 Health Services (Fees) Law (1998 Revision) PART 3 - Inclusive Fees-Major Cases Notes: (1) The fee for a service specified in this Part covers - (a) the surgeon’s fees; and (b) use of the operating theatre. (2) It does not cover - (a) hospitalisation; (b) biopsy changes; (c) the cost of any drugs, medicines or any prosthesis or other implants; or (d) anaesthesia charges which will be charged at the rate of $100 plus $50 for each half hour or part of a half hour after the first hour. (3) If a doctor’s or surgeon’s assistant is provided an additional fee of $50 for each hour or part of an hour during which he is provided will be charged. 59. Major surgical cases- (1) Vaginal hysterectomy 600 (2) Gastrectomy with anastomosis 600 (3) Bowel resection 600 (4) Nephrectomy 700 (5) Mastectomy- local 400 radical 600 (6) Craniotomy burr holes- first hour 500 each hour thereafter 100 (7) Tuboplasty 500 (8) Embolectomy- first hour 500 each hour thereafter 100 (9) Osteotomy bone 250 (10) Arthroscopy without shaving 400 with shaving 500 (11) Trans urethral resection of the prostate 500 (12) Cholecystectomy with operative cholangiogram 500 (13) Open reduction of fractured hip- Smith Petersen pin and plate 500 (14) Hip compression 500 (15) Austin Moore hip replacement 500 (16) Open reduction of fractured femur - K-nail insertion 400 (17) Open reduction of fracture - radius and ulna or tibia and 300 fibula using rush rods (18) Open reduction of fracture- radius and ulna or tibia and 300 fibula using K-wire (19) Open reduction of fracture- radius and ulna or tibia and 300 fibula using stainless steel (20) Open reduction of fracture redium and ulna or tibia and 300 fibula using plate and screws 60. Major other cases 12 Health Services (Fees) Law (1998 Revision) (1) Dental restoration- under 1 hour 200 1 hour or over 360 (2) Ovarian cystectomy 350 (3) Caesarean section-including midwife and paediatrician 500 (4) Cholecystectomy 400 (5) Ventral suspension of uterus 350 (6) Patellectomy 400 (7) Splenectomy 500 (8) Laparotomy 400 (9) Laparotomy for ectopic pregnancy 500 (10) Closure of colostomy 350 (11) Open reduction of fracture of metacarpal or phalange, 400 tarsal or materials including plates, screws, etc. (12) Amputation of limb-arm or leg 600 (13) Myomectomy 400 (14) Thyroidectomy 500 (15) Anterior colporrhapy 350 (16) Posterior colporrhapy 350 (17) (15) and (16) combined 500 (18) Dermolipectomy: first hour 500 each hour thereafter 100 (19) Wiring of fractured mandible 350 (20) Bunionectomy- one 350 two 500 (21) Tendon and blood vessel repair 500 (22) Stripping of varicose veins -legs- first hour 300 each hour thereafter 100 (23) Hernia repair- umbilical 250 single side 300 both sides 500 (24) Cataract extraction 550 (25) Cataract extraction with implant 600 (26) Mammary reduction 500 (27) Insertion of implant in breast 400 (28) Insertion of implant in breast after previous surgery 500 (29) Abdominal hysterectomy 500 (30) Corneal transplant 800 13 Health Services (Fees) Law (1998 Revision) Publication in revised form authorised by the Governor in Council this 16th day of June, 1998. Carmena H. Parsons Clerk of Executive Council Note (not forming part of the Law): By notice dated 29th October, 1992 and published in Gazette No. 23 of 16th November, 1992, H.E. the Governor confirmed that, under section 5 of the Interpretation Law (1995 Revision), the person for the time being carrying out the duties of the office of Medical Officer of Health is the Government Chief Medical Officer. 14