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Insurance coverage, access to care top concerns among transgender adults in southern US

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January 9, 2019

Transgender adults living in Arkansas cited insurance hurdles, access to transgender care and provider education as their top health care concerns, as well as a need for public education to address stigma and discrimination, according to survey findings published in Transgender Health.

“Utilization of gender-affirming medical treatment, also known as transition-related care, may be a protective factor for health disparities among trans individuals, particularly trans women, especially in mental health and substance use,” Sarah Alexandra Marshall, PhD, MPH, CPH, CHES, assistant professor in the department of health behavior and health education and health policy and management at the University of Arkansas for Medical Sciences in Little Rock, and colleagues wrote in the study background. “However, access to affirming care is an issue for many trans/[nonbinary] individuals. One out of four transgender individuals that completed the 2015 U.S. Transgender Survey reported experiencing issues with health care coverage, including being denied coverage for transition care, hormones, transition-related surgeries or other routine care because they were transgender.”

Marshall and colleagues analyzed data from 125 adults identifying as transgender or nonbinary (n = 96; 80.2% white) and their cisgender partners or family members (n = 29; 75.9% white) who lived in a southern state and completed a survey distributed through multiple methods, including online, in-person and at nine summits between July 2015 and April 2016. The survey included the open-ended question, “Please list up to five transgender health or health care-related issues you are most concerned about and you would like this research group to focus on in order of their importance to you.” Researchers used logistic regression analysis to isolate variables predicting an outcome of individuals ranking one of the top three concerns identified in a frequency analysis of results, including insurance, access to care and provider education.

Among adults who identified as transgender or nonbinary, 19 identified as heterosexual, 14 were gay or lesbian, 44 were bisexual, 12 identified as asexual and seven identified as questioning or preferred not to state sexual orientation. Seven of 10 participants were employed at the time of the survey, and 88% reported having health insurance.

In qualitative analysis, researchers identified 10 themes of concern to participants, including insurance coverage, access to transition-related care, education of health care providers about trans issues, public education, health care systems and policies that support transgender individuals, access to trans-knowledgeable mental health providers and concerns for transgender participants. More than half of cisgender and transgender participants cited insurance, access to care and provider education as the top three concerns, according to researchers. Researchers found that participants who reported having health insurance were more likely to indicate insurance as a top health care concern (P = .008).

The researchers noted that the findings “take on greater weight” in the conservative cultural context of the study, which was conducted in one of the most highly religious states in the U.S.

“Interestingly, one of the few significant associations in our regression analyses indicated that participants who reported having health insurance were more likely to list coverage for gender-affirming care as a top concern,” the researchers wrote. “This finding is not surprising given that most health plans in Arkansas explicitly exclude coverage for such care.”

The researchers added that more study is needed about how the knowledge, attitudes and behaviors of health care providers in the South differ from those in other regions of the U.S., as this would inform tailored interventions to improve health care access for transgender individuals. – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.

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