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Association of Insurance Policies with Gender Affirming Surgery in California
Anna Schoenbrunner, Annamarie Beckmeyer, Adrian Diaz
The Ohio State University
2022-01-14
Presenter: Anna Schoenbrunner
Affidavit:
This work is the author's own
Director Name: Gregory Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose: Gender affirming (GA) surgery is an important part of transition related care for patients with gender dysphoria. Access to GA surgery varies based on insurance status and insurance policies. We hypothesize that frequency of GA surgery increased in California after implementation of the Affordable Care Act (ACA) and the California Insurance Gender Nondiscrimination Act (IGNA).
Methods:
Using California's Office of Statewide Health Planning and Development databases we identified patients with a diagnosis for gender dysphoria from 2005 to 2016. We performed interrupted time series analysis to evaluate whether GA surgery increased following the implementation of the ACA and IGNA.
Results:
Overall, 4,246 chest and genital gender affirming operations occurred in California from 2005 to 2016. There were 2,880 (67.8%) chest surgeries and 1,453 (34.22%) genital surgeries. Interrupted time series analysis demonstrated that after implementation of the IGNA and ACA, frequency of GA surgery increased by 18.3 (95% CI: 14.7-21.9, p<0.005) per quarter. For privately insured patients specifically, GA surgery increased by 22.8 (95% CI: 6.0 to 39.6, p<0.005) immediately after policy implementation. For self-pay patients there was an immediate decrease of GA surgery by 16.3 (95%CI: 4.1 to 28.4, p = 0.010). For patients with Medi-Cal, GA surgery increased by 5.4 (95% CI: 5.6 to 6.1, p<0.005) per quarter.
Conclusion:
GA surgery became more common among privately and Medi-Cal insured patients, and less common among self-pay patients after the IGNA and ACA were enacted. These findings suggest that changes in insurance policies mandating coverage for GA surgery can increase access to care.
