Bakko Matthew, Kattari Shanna K
School of Social Work, Department of Sociology, University of Michigan, Ann Arbor, MI, USA.
School of Social Work, Department of Women's Studies, University of Michigan, Ann Arbor, MI, USA.
J Gen Intern Med. 2020 Jun;35(6):1693-1700. doi: 10.1007/s11606-020-05724-2. Epub 2020 Mar 3.
Insurance-based denials are common barriers for transgender and non-binary individuals in accessing medically necessary gender-affirming care. Little is known about how experiences of transgender-related insurance denials may vary by insurance type.
This study investigates the association between transgender and non-binary individuals' experiences of different forms of transgender-related insurance denials and insurance type.
The 2015 United States Transgender Survey was conducted by the National Center for Transgender Equality to ascertain US transgender and non-binary experiences across multiple life experiences, including individual health status, health services access and utilization, and experiences with denials.
Multivariate logistic regressions were conducted, and adjusted risk ratios were calculated, to analyze the likelihood of experiencing eight different forms of denials by insurance type, including private, Medicare, Medicaid, and military-related, and having multiple types of insurance coverage.
Models revealed significant relationships between transgender-related insurance denials and insurance type for 11,320 transgender and non-binary adults. Compared with those with private insurance, Medicaid coverage was associated with an increased likelihood of experiencing denials for hormone therapy (adjusted risk ratio (ARR) = 1.22; CI = 1.05-1.42; p = 0.02); having no in-network surgery providers was associated with Medicare (ARR = 1.84; CI = 1.29-2.62; p = 0.009) or Medicaid (ARR = 1.54; CI = 1.20-1.98; p = 0.003); and military-based insurance was associated with transition-related surgery denials (ARR = 1.53; CI = 1.36-1.72; p < 0.001).
Researchers and practitioners must consider the link between type of insurance coverage and experiences with different forms of transgender-related insurance denial. These results provide continuing support for broad non-discrimination policy efforts, but also direct our attention to targeted insurance policy interventions by form of denial, which can promote equitable access for transgender and non-binary people across all healthcare needs.
基于保险的拒付是跨性别者和非二元性别者获得必要的性别确认医疗服务的常见障碍。对于与跨性别相关的保险拒付经历如何因保险类型而异，人们知之甚少。
本研究调查跨性别者和非二元性别者不同形式的与跨性别相关的保险拒付经历与保险类型之间的关联。
2015年美国跨性别者调查由美国跨性别平等中心开展，以确定美国跨性别者和非二元性别者在多种生活经历中的情况，包括个人健康状况、医疗服务的获取与利用以及拒付经历。
进行多变量逻辑回归分析并计算调整后的风险比，以分析按保险类型（包括私人保险、医疗保险、医疗补助和军事相关保险）经历八种不同形式拒付以及拥有多种保险覆盖类型的可能性。
模型显示，对于11320名跨性别和非二元性别成年人，与跨性别相关的保险拒付和保险类型之间存在显著关系。与拥有私人保险的人相比，医疗补助覆盖与激素治疗拒付可能性增加相关（调整后的风险比（ARR）=1.22；置信区间（CI）=1.05-1.42；p=0.02）；没有网络内手术提供者与医疗保险（ARR=1.84；CI=1.29-2.62；p=0.009）或医疗补助（ARR=1.54；CI=1.20-1.98；p=0.003）相关；基于军事的保险与过渡相关手术拒付相关（ARR=1.53；CI=1.36-1.72；p<0.001）。
研究人员和从业者必须考虑保险覆盖类型与不同形式的与跨性别相关的保险拒付经历之间的联系。这些结果为广泛的非歧视政策努力提供了持续支持，但也将我们的注意力引向按拒付形式进行有针对性的保险政策干预，这可以促进跨性别者和非二元性别者在所有医疗需求方面获得公平的服务。
