Walton Eric, Manda Pranay, Patil Dattatraya, Mehta Akanksha
Department of Urology, Emory University School of Medicine, Atlanta, GA.
Department of Urology, Emory University School of Medicine, Atlanta, GA.
Urology. 2024 Aug;190:156-161. doi: 10.1016/j.urology.2024.05.025. Epub 2024 Jun 2.
To examine the temporal relationship between the anti-discrimination rules of the Affordable Care Act, which took full effect in 2017, and the incidence of commercial claims for gender-affirming care, as well as cost sharing for these services.
We used a previously described algorithm to define a cohort of gender-diverse adults in the MarketScan Commercial Claims and Encounters Database. Claims for gender-affirming medical and surgical care were identified using International Classification of Diseases and Current Procedural Terminology codes plus pharmacy data; the annual incidence of surgical claims was calculated. Interrupted time series analyses were used to evaluate the temporal relationship between claims and anti-discrimination legislation. Claims data were also used to evaluate the patient contribution towards services.
There were 70,733 gender-diverse adults included in the study and 36,702 (51.9%) of them filed claims for gender-affirming care. The incidence of persons with claims for gender-affirming surgery increased from 0.002% in 2009 to 0.012% in 2021. Interrupted time series analyses demonstrated a greater year-to-year increase in claims after anti-discrimination policy influences took effect. This change was greatest for transmasculine chest procedures. The median lifetime net payment for gender-affirming surgery was $12,429.10 and cost sharing was $1019.20 (8.6%).
Commercial claims for gender-affirming surgery increased temporally with respect to implementation of anti-discrimination legislation and cost-sharing was reasonably low. However, many gender-diverse persons did not have claims for gender-affirming care, which may indicate continued out-of-pocket payment for these services.
研究2017年全面生效的《平价医疗法案》中的反歧视规则与性别肯定治疗商业索赔发生率以及这些服务的费用分摊之间的时间关系。
我们使用先前描述的算法在MarketScan商业索赔和就诊数据库中定义了一组性别多样化的成年人。使用国际疾病分类和当前程序术语代码以及药房数据识别性别肯定医疗和手术护理的索赔；计算手术索赔的年发生率。采用中断时间序列分析来评估索赔与反歧视立法之间的时间关系。索赔数据还用于评估患者对服务的贡献。
该研究纳入了70733名性别多样化的成年人，其中36702人（51.9%）提交了性别肯定护理的索赔。性别肯定手术索赔者的发生率从2009年的0.002%增加到2021年的0.012%。中断时间序列分析表明，在反歧视政策影响生效后，索赔的年增长率更大。这种变化在男性化胸部手术中最为明显。性别肯定手术的终身净支付中位数为12429.10美元，费用分摊为1019.20美元（8.6%）。
性别肯定手术的商业索赔在时间上随着反歧视立法的实施而增加，且费用分摊相当低。然而，许多性别多样化的人没有性别肯定护理的索赔，这可能表明这些服务仍需自掏腰包支付费用。
