Barriers and facilitators to publicly-funded gender-affirming surgery: The perspectives amongst a cohort of Australian clinicians

Abstract

Background: Barriers to publicly-funded gender-affirming surgery (GAS) in Australia have been identified as cost, limited availability of qualified providers and lack of public hospital systems performing/offering these services. Our study explores barriers, facilitators, and potential implications for expanding, and improving publicly-funded GAS in Australia from the perspectives of an Australian cohort of gender-affirming clinicians. Methods: We conducted semi-structured interviews with eight clinicians who currently work within gender-affirming health services in Queensland, Australia. Through ecological systems theory, gender minority stress framework, and reflexive thematic analysis, themes and subthemes were identified. Results: Our study identified three themes and five sub-themes exploring the barriers and facilitators to publicly-funded GAS in Queensland, Australia. The first theme “I don’t know how this it’s ever going to happen” captures participant concerns that gender-affirming surgery is a misunderstood intervention within the wider medical community and this perception impedes progress of publicly-funded GAS. The second theme, “Hoping Against Hope” depicts the double-edged dilemma of maintaining hope of accessing surgery even if it is “unrealistic.” The last, and third theme, “No if, When” depicts the certainty amongst participants that publicly-funded GAS is inevitable and will become a reality in Queensland, Australia. Conclusions: Gender-affirming clinicians indicated establishing a surgical center for excellence in trans and non-binary healthcare is an essential facilitator needed to implement publicly-funded GAS. This would allow for a best-practice decentralized model of gender-affirming care to be realized in future to optimize health and wellbeing among trans and non-binary persons. Thereremain substantial barriers, specifically at exosystem and macrosystem levels, within the public health service needing urgent attention. Implications of findings are relevant to funding, clinical practice, research, and policy within and beyond Australia.