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Impact of Anti-Discrimination Legislation on Access to Gender-affirming Care: A Commercial Claims Analysis.
Walton, Eric; Manda, Pranay; Patil, Dattatraya; Mehta, Akanksha.
Afiliación
  • Walton E; Department of Urology, Emory University School of Medicine, Atlanta, GA. Electronic address: ewalto4@emory.edu.
  • Manda P; Department of Urology, Emory University School of Medicine, Atlanta, GA.
  • Patil D; Department of Urology, Emory University School of Medicine, Atlanta, GA.
  • Mehta A; Department of Urology, Emory University School of Medicine, Atlanta, GA.
Urology ; 190: 156-161, 2024 Aug.
Article en En | MEDLINE | ID: mdl-38834147
ABSTRACT

OBJECTIVE:

To examine the temporal relationship between the anti-discrimination rules of the Affordable Care Act, which took full effect in 2017, and the incidence of commercial claims for gender-affirming care, as well as cost sharing for these services.

METHODS:

We used a previously described algorithm to define a cohort of gender-diverse adults in the MarketScan Commercial Claims and Encounters Database. Claims for gender-affirming medical and surgical care were identified using International Classification of Diseases and Current Procedural Terminology codes plus pharmacy data; the annual incidence of surgical claims was calculated. Interrupted time series analyses were used to evaluate the temporal relationship between claims and anti-discrimination legislation. Claims data were also used to evaluate the patient contribution towards services.

RESULTS:

There were 70,733 gender-diverse adults included in the study and 36,702 (51.9%) of them filed claims for gender-affirming care. The incidence of persons with claims for gender-affirming surgery increased from 0.002% in 2009 to 0.012% in 2021. Interrupted time series analyses demonstrated a greater year-to-year increase in claims after anti-discrimination policy influences took effect. This change was greatest for transmasculine chest procedures. The median lifetime net payment for gender-affirming surgery was $12,429.10 and cost sharing was $1019.20 (8.6%).

CONCLUSION:

Commercial claims for gender-affirming surgery increased temporally with respect to implementation of anti-discrimination legislation and cost-sharing was reasonably low. However, many gender-diverse persons did not have claims for gender-affirming care, which may indicate continued out-of-pocket payment for these services.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Patient Protection and Affordable Care Act / Accesibilidad a los Servicios de Salud Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Urology Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Patient Protection and Affordable Care Act / Accesibilidad a los Servicios de Salud Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Urology Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos