Legislations Mandating Insurance Coverage Are Highly Effective In Delivering Surgical Care Of Transgender Patients
Adam Faletsky, BS1, Michael Jonczyk, MD2, Lifei Guo, MD, PhD2.
1Tufts School of Medicine, Boston, MA, USA, 2Lahey Hospital & Medical Center, Burlington, MA, USA.
PURPOSE:
While gender-affirming surgeries are becoming widely performed, few studies have examined any temporal correlation between legislations mandating transgender care and the actuation of such surgical care.
METHODS:
We assembled a retrospective cohort utilizing the National Inpatient Sample (NIS) database from 2000 to 2018. We segregated all major payers in NIS into two groups: 1) those impacted by state-specific legislature, i.e., Medicaid and private insurance, and 2) those not impacted by state-specific legislature, i.e., Medicare and self-pay. All regions according to the latest NIS categorization were examined based on the nature of their member state's legislations relating to gender-affirming care coverage. Diametrically opposite regions were selected for further comparisons. Interrupted time series analyses were used to demonstrate any significant uptrend since relevant legislations.
RESULTS:
In states with explicit inclusion of gender-affirming care, our interrupted time series analyses showed a significant increase in the number of patients covered under state legislation-dependent insurance receiving gender affirming surgeries around the time during which state legislations began mandating care (p<0.01) and in the years thereafter (p<0.01). This significance was not seen among the same regions for patients covered under non-state legislation-dependent insurance. Nor was it seen in either payer group in states without explicit inclusion of gender-affirming care. At the federal level, Medicare recipients exhibited a statistical significance among all states analyzed, regardless of coverage, around the time federal legislations took effect and in the years thereafter.
CONCLUSION:
Legislations mandating coverage appear highly effective in actuating surgical care of transgender patients in corresponding jurisdictions.
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