Impact of Payment Models and Legislation on Gender Affirming Surgery

支付模式和立法对性别确认手术的影响

• 批准号: 10387232
• 负责人: Megan Lane
• 金额: $ 8.46万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10387232
• 关键词: Impact; Payment; Models; Legislation; Gender

Project Summary An estimated 1.4 million Americans identify as transgender, defined as incongruence between one’s gender and their gender assigned at birth. For many transgender people, having primary and secondary sex characteristics that align with their gender is essential to mental, emotional, and physical wellbeing as well as their ability to meaningfully engage in social roles. Gender-affirming surgery allows patients to change their primary and secondary sex characteristics through a variety of operations, including vaginoplasty, phalloplasty, gender-affirming mastectomy, breast augmentation, and facial feminization. The number of individuals seeking gender-affirming procedures has increased dramatically in recent years, with over 8,000 gender-affirming procedures performed in the United States in 2017 alone. Despite their effectiveness, gender-affirming procedures are costly, and often prohibitively expensive for most patients without insurance coverage. Fortunately, many insurance carriers provide coverage for gender- affirming procedures, but most require prior authorization processes and do not offer uniform coverage for all types of procedures. Further, coverage for these procedures varies geographically, and depends on both state and federal legislation. As such, the effects of policy and payment models on the accessibility of gender- affirming surgery remains unclear. In this two-year study, we will quantitatively and qualitatively examine the impact of legislative measures and payment models on the rates of gender-affirming surgery. We specifically aim to: 1) assess the effect of payment models on access to these operations via the patient perspective and 2) utilize claims database analysis to determine the association of the enactment of the Affordable Care Act and rates of gender-affirming surgery. Results from this mixed-methods investigation are critical to evaluating the efficacy of policy affecting gender-affirming surgery and guide future legislation. The robust methodology proposed in this study alongside the rigorous coursework through the National Clinician Scholars Program will prepare Dr. Lane for a career as a surgeon-scientist with deep expertise in the application of health services research to enhance the care of transgender individuals.

项目摘要 估计有140万美国人认为是跨性别者，被定义为性别之间的不一致 他们的性别在出生时分配。对于许多跨性别者，有初级和继发性 与性别保持一致的特征对于心理，情感和身体健康至关重要 他们有意义地参与社会角色的能力。性别表达手术允许患者改变他们的 通过各种操作，包括阴道，膜成形术， 性别乳房切除术，隆胸和面部女性化。寻求的个人人数 近年来，性别肯定程序已大大增加，有8,000多个性别肯定 仅2017年在美国执行的程序。 尽管它们有效，但性别肯定程序还是昂贵的，并且通常禁止大多数人昂贵 没有保险保险的患者。幸运的是，许多保险公司为性别提供覆盖范围 影响程序，但大多数需要事先授权流程，并且不为所有人提供统一的承保范围 程序类型。此外，这些程序的覆盖范围在地理上有所不同，并取决于两种状态 和联邦立法。因此，政策和付款模型对性别可及性的影响 - 肯定的手术尚不清楚。在这项为期两年的研究中，我们将定量和定性地检查 立法测量和支付模型对性别肯定手术率的影响。我们具体 目的：1）通过患者的角度评估付款模型对访问这些操作的影响， 2）利用索赔数据库分析来确定《平价医疗法》制定法的关联 和性别肯定手术的率。这项混合方法研究的结果对于评估 影响性别肯定手术并指导未来立法的政策效率。强大的方法 在这项研究中，与国家临床学者计划的严格课程一起提出了 为Lane博士做准备，成为具有深厚专业知识的外科医生科学家的职业生涯 研究以增强跨性别者的护理。