Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost-Effectiveness Analysis

Padula, William V.; Heru, Shiona; Campbell, Jonathan D.

doi:10.1007/s11606-015-3529-6

Cited by 107 publications

(66 citation statements)

References 28 publications

(27 reference statements)

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“…Multiple observational studies have suggested significant and sometimes dramatic reductions in suicidality, suicide attempts, and suicides among transgender patients after receiving transition-related treatment (State of California, 2012, p. 10). A study by Padula, Heru, and Campbell (2015) found that removing exclusions on transgender care "could change the trajectory of health for all transgender persons" at a minimal cost per member per month. 8 However, we caution that it is not known how well these findings generalize to military personnel.…”

Section: Potential Consequences Of Not Providing Necessary Gender Tramentioning

confidence: 99%

Assessing the Implications of Allowing Transgender Personnel to Serve Openly

Schaefer¹,

Iyengar²,

Kadiyala³

et al. 2016

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This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.html.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org Library of Congress Cataloging-in-Publication Data is available for this publication.ISBN: 978-0-8330-9436-0 For more information on this publication, visit www.rand.org/t/RR1530Published by the RAND Corporation, Santa Monica, Calif. © Copyright 2016 RAND CorporationR® is a registered trademark.iii Preface U.S. Department of Defense (DoD) policies have rendered both the physical and psychological aspects of "transgender conditions" as disqualifying conditions for accession and allow for the administrative discharge of service members who fall into these categories. However, in July 2015, Secretary of Defense Ashton Carter announced that DoD would "create a working group to study the policy and readiness implications of welcoming transgender persons to serve openly." In addition, he directed that "decision authority in all administrative discharges for those diagnosed with gender dysphoria 1 or who identify themselves as transgender be elevated to the Under Secretary of Defense (Personnel and Readiness), who will make determinations on all potential separations" (DoD, 2015b).It is against this backdrop that DoD is considering allowing transgender personnel to serve openly. To assist in identifying the potential implications of such a change in policy, the Office of the Under Secretary of Defense for Personnel and Readiness asked the RAND National Defense Research Institute to conduct a study to (1) identify the health care needs of the transgender population, transgender service members' potential health care utilization rates, and the costs associated with extending health care coverage for transition-related treatments; (2) assess the potential readiness implications of allowing transgender service members to serve openly; and (3) review the experiences of foreign militaries that permit transgender service members to serve openly. This report documents the findings from that study. This research should be of interest to DoD and military service leadership, members of Congress, and others who are in...

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Section: Potential Consequences Of Not Providing Necessary Gender Tramentioning

confidence: 99%

Assessing the Implications of Allowing Transgender Personnel to Serve Openly

Schaefer¹,

Iyengar²,

Kadiyala³

et al. 2016

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“…A lack of individuals with relevant training may prolong already lengthy wait times for patients seeking transgender-specific surgical care in the United States. [5][6][7] No studies to date have evaluated the degree to which surgical residents are educated in the care of the transgender patient. 5,[8][9][10][11] This study aims to describe the level of transgender-oriented education currently provided in surgical training programs, a surrogate for the surgical community's preparedness to treat patients seeking gender transition.…”

Section: Introductionmentioning

confidence: 99%

Transgender-Related Education in Plastic Surgery and Urology Residency Programs

Morrison¹,

Dy²,

Chong³

et al. 2017

Journal of Graduate Medical Education

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“…), and the explicit exclusion of trans‐ specific coverage from insurances in particular (Padula and Baker ; Padula et al. ), there simply are not enough trained surgeons in the United States to respond to the rapid increased demand for trans‐ surgery (Arnold et al. ; Harvard Pilgrim Healthcare Foundation ; Puckett et al.…”

Section: The Past and Rapidly Changing Present Of Us Trans‐ Medicinmentioning

confidence: 99%

“…Following decades in which trans-surgical specialists were marginalized and prospective patient demand was poorly understood due to the difficulty of quantifying the trans-population in general (Reisner et al 2015), 11 and the explicit exclusion of trans-specific coverage from insurances in particular (Padula and Baker 2017;Padula et al 2016), there simply are not enough trained surgeons in the United States to respond to the rapid increased demand for trans-surgery (Arnold et al 2017;Harvard Pilgrim Healthcare Foundation 2017;Puckett et al 2017;Rowniak et al 2017;Shukla et al 2014). In addition to a shortage of technical expertise, clinicians, administrators, and prospective patients are now challenged to integrate the unique best-practice treatment program of transition-related medicine into health care systems whose policies, practices, and workflows have explicitly excluded it for more than three decades.…”

Section: The Past and Rapidly Changing Present Of Us Trans-medicinementioning

confidence: 99%

A Capable Surgeon and a Willing Electrologist: Challenges to the Expansion of Transgender Surgical Care in the United States

Plemons

2019

Med Anthropol Q

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Since 2014, public and private insurance coverage for transgender Americans’ surgical care has increased exponentially. Training clinicians and equipping institutions to meet the surge in demand has not been as rapid. Through ethnographic research at a surgical workshop focused on trans‐ genital reconstruction and in a U.S. hospital working to grow its transgender health program, this article shows that effects of the decades‐long insurance exclusion of trans‐ surgery are not easily remedied through the recent event of its inclusion because patient access is not the only thing that has been restricted by coverage denial. Decades of excluding coverage for trans‐ genital reconstructive surgery have limited the development and circulation of technical skills required to perform these procedures, as well as the administrative processes needed to integrate them into existing clinical workflows. One surgeon estimates that turning expanded access into realized care is “a five or six‐year problem.”

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Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost-Effectiveness Analysis

Cited by 107 publications

References 28 publications

Assessing the Implications of Allowing Transgender Personnel to Serve Openly

Assessing the Implications of Allowing Transgender Personnel to Serve Openly

Transgender-Related Education in Plastic Surgery and Urology Residency Programs

A Capable Surgeon and a Willing Electrologist: Challenges to the Expansion of Transgender Surgical Care in the United States

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