Bond Stephanie M, Fouche Tom, Smith Jesse R, Garza Rebecca M
Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medicine & Biological Sciences, Chicago, Illinois, USA.
Pritzker School of Medicine, University of Chicago Biological Sciences Division, Chicago, Illinois, USA.
Transgend Health. 2022 Nov 29;7(6):484-496. doi: 10.1089/trgh.2020.0146. eCollection 2022 Nov.
An increasing number of individuals who present to health care professionals identify as transgender, gender nonconforming (GNC), and gender nonbinary (NB). GNC/NB individuals experience higher rates of discrimination in health care settings compared with their binary (e.g., trans male and trans female) counterparts. Outdated language excludes the nuances of gender identity. The goal of this study was to evaluate whether current terminology found in health insurance policies may be a barrier to gender-affirming health care for GNC/NB individuals.
Health insurance policies for a diverse subset of government (=4) and private (=6) payers were obtained in May 2020. Policies were reviewed independently by two members of the research team to determine whether each was supportive or unsupportive to GNC/NB individuals. An arbitrary scoring system was designed that allowed the reviewers to assign a specific number of points to each policy based on the aggregation of mention, coverage, and inclusivity.
Most policies performed poorly as indicated by a support score less than zero. It was also noted that most policies used binary, gendered language, and terminology that excludes the unique gender identities of many GNC/NB individuals.
Most policies currently failed to provide clear, inclusive coverage to GNC/NB individuals for relevant and important aspects of their care. In their current state, these policies are a source of confusion, uncertainty, and discouragement for these individuals, which can present as a barrier to accessing quality, inclusive, gender-affirming health care.
越来越多寻求医疗保健专业人员帮助的人认定自己为跨性别者、性别不一致者（GNC）和性别非二元者（NB）。与二元性别者（如跨性别男性和跨性别女性）相比，GNC/NB个体在医疗保健环境中遭受歧视的比例更高。过时的语言无法涵盖性别认同的细微差别。本研究的目的是评估医疗保险政策中目前使用的术语是否可能成为GNC/NB个体获得性别肯定性医疗保健的障碍。
2020年5月获取了政府（=4）和私人（=6）不同支付方的医疗保险政策。研究团队的两名成员独立审查这些政策，以确定每项政策对GNC/NB个体是支持还是不支持。设计了一个任意评分系统，使审查人员能够根据提及、覆盖范围和包容性的汇总情况为每项政策分配特定分数。
如支持分数低于零所示，大多数政策表现不佳。还注意到，大多数政策使用二元性别、带有性别色彩的语言和术语，这些排除了许多GNC/NB个体独特的性别认同。
目前大多数政策未能为GNC/NB个体护理的相关重要方面提供明确、包容的覆盖范围。就目前的状况而言，这些政策给这些个体带来了困惑、不确定性和气馁，这可能成为他们获得高质量、包容性、性别肯定性医疗保健的障碍。
