Daphna Stroumsa, an obstetrics and gynecology resident at Henry Ford Hospital in Detroit, has published research on medical discrimination against transgender people whichis available in the American Journal of Public Health: The State of Transgender Health Care: Policy, Law and Medical Frameworks. Access to the full document requires APHA membership or paid subscription, which I do not have.
I review the current status of transgender people’s access to health care in the United States and analyze federal policies regarding health care services for transgender people and the limitations thereof. I suggest a preliminary outline to enhance health care services and recommend the formulation of explicit federal policies regarding the provision of health care services to transgender people in accordance with recently issued medical care guidelines, allocation of research funding, education of health care workers, and implementation of existing nondiscrimination policies. Current policies denying medical coverage for sex reassignment surgery contradict standards of medical care and must be amended.
Dr. Strousma is a graduate of The Hebrew University Haddassah Medical School in Jerusalem, Israel. She calls for the medical establishment to immediately address of the situation.
Bias against transgender people takes an enormous toll on their health through direct harm, lack of appropriate care and a hostile environment, and through transgender people’s avoidance of the medical system as a result of discrimination and lack of respect. The medical establishment has a duty, and an ability, to protect transgender patients from such harms.
Frustration with health care professionals is considered to be one of the top triggers of suicide attempts by transgender people. The recent Williams Institute/American Foundation for Suicide Prevention study (Suicide Attempts among Transgender and Gender Non-Conforming Adults) disclosed that 60% of those of us who had attempted suicide reported having been refused treatment by a healthcare provider.
Stroumsa assigns top priority to all health programs funded by the federal goverment (the VA, Medicaid and Medicare, and the Children's Health Insurance Program) calling for them to be required to provide coverage of care, including sex reassignment surgery, while transgender patients make the physical transition to the sex matching their gender identity.
Private insurance may ultimately follow adoption of full coverage by federally funded programs. But until it does, federal guidelines protecting transgender people from discrimination by private insurance companies is warranted, including a ban on the practice of denying medical care coverage by linking the care to transition, which is not covered under most policies.
While the Affordable Care Act includes gender identity in its nondiscrimination policy, it is unclear exactly how protected transgender patients will be from denial of coverage. And because transgender people are not protected from workplace discrimination, we are more statistically more likely to have no insurance coverage...and so need what coverage the AFA provides.
Strousma also calls for the medical establishment to include transgender-sensitive care in all medcial education "as has been done with other cultural competencies." So she calls for federal grants to help fund educational teaching postgraduate-level medical care of transgender patients, including how to perform sex reassignment surgery. The AFA provides funding for LGBT cultural competency trainingwhich has already been implemented in some major urban medical centers.
- Establish more health centers dedicated to caring for transgender patients as well as strengthen those already in operation.
- Draft clear guidelines for all federally funded health centers, including appropriate language, adoption of gender-neutral bathrooms and health records that respect transgender patients' preferred names and gender pronouns.
- Include questions regarding gender identity in health surveys to help monitor the progress and effects of new transgender health care measures.
- Help overcome the high rates of unemployment in the transgender population by hiring transgender people in the health care workforce. This would also offer an important avenue to address some of the challenges and barriers this population faces in the health care system.
- Those who care for transgender patients should collect and publish data with the goal of improving that care.
It goes without saying that all such research must be conducted with sensitivity and respect toward participants.
No, it doesn't go without saying. It needs to be said loudly and often.