For a Graduated Scale of Fees for Legal Abortion

Abstract

This article argues that the fee scale for abortions performed in outpatient clinics should be graduated to reflect the degree of difficulty of the procedure, the clinical skill, time, and equipment required, and the risks of morbidity and mortality. The trimester approach currently used encourages delay within the first trimester and excessively pensalizes those obtaining abortions in the 12th or 13th weeks. The graduated-fee approach would be scaled to the length of gestation based on objective criteria such as a postoperative measurement of fetal foot size. The fee would increase with the length of gestation. Such an approach would encourage women to seek abortions as early as possible. Problems of determining a baseline fee, selecting a time frame for specifying gestational age, setting an index gestational age and establishing objective measures of it, providing routine methods for inspecting the products of conception, avoiding inflicting emotional trauma on the patients, establishing fee collection procedures, and monitoring facilities using the system would have to be resolved before a graduated fee system could be implemented. The routine inspection of all products of conception would aid early diagnosis of such conditions as ectopic pregnancy and incomplete abortion. Encouraging earlier performance of abortions should lead to a reduction in the clinic's overall complication rate.