Transgender

 

トランスジェンダーの医療介入:新たなデータ領域(英語版のみ)


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トランスジェンダーの治療や手術の件数が上昇する中で、医療の専門家や保険会社がこの新しい領域を正確に評価する役に立つより良いデータや分析が必要です。

社会のある側面が急激に変化するとき、データおよび分析がその領域の専門家が迅速かつ適切に対応する際の役に立ちます。現在、ヘルスケア・セクターにおける重要な変化は、性同一性の治療を受けている人の数です。

カリフォルニア大学ロサンジェルス校法科大学院ウイリアムズ研究所(Williams Institute at UCLA School of Law)の新たな推計によると、米国だけでも140万人が自分自身がトランスジェンダーであることを明かしており、5年前の2倍に上っています1。このレポートは、この増加が、トランスジェンダーの人たち対する社会的受容やトランスジェンダーの人たちが目に見えるようになったことにより、認知度が上昇したことと、データ収集が加速したことなどによるものとしています。一方、英国では、性同一性障害のクリニックへの照会が大幅に増加しています2

しかしながら、トランスジェンダーのヘルスケアに関するデータは多くありません。米国、英国を含む多くの国で、最近の調査や他の公的研究では、参加者に性別確認の質問をしていません。性別確認の質問をしている国々の中では、トランスジェンダーを自認する多くの人は差別や偏見を恐れて公的書式で回答しないことを望むと考えられるため、回答率は低くなっている可能性があります。

カリフォルニアのジョン・F・ケネディー大学(John F Kennedy University)臨床心理学博士であり、トランスジェンダーの健康のための世界専門職協会(World Professional Association of Transgender Health)会員であるDr Erica Andersonによると、多くの事情が正確な報告を阻んでいます。これには、シスジェンダー(生まれ持った性別と心の性が一致している人に用いられる言葉)ではない人々を示す用語の問題も含まれます。

「統一性はほとんどありません。こうした情報を捉えた調査やデータベースは、ほとんどなく、信頼できる過去のデータはありません。」と彼女は言います。その一方で、入手可能なデータソースによると、「トランスジェンダーあるいは性の不一致を自認する人はあらゆる年齢層にいて、かつて考えられていたよりも多く、おそらく200人に一人というほど一般的です。」と続けます。

Why professionals need data on transgender people and their healthcare needs

Healthcare systems rely on robust data and analytics to design and manage health insurance policies that accurately reflect the risks and costs of underlying insurance benefits. New or emerging coverages for which there is a lack of data can present challenges requiring creative solutions.

“An increasing number of health insurance plans are starting to cover gender confirmation surgeries and associated treatments, including Medicaid and Medicare in the US.”

An increasing number of health insurance plans are starting to cover gender confirmation surgeries, including Medicaid and Medicare in the US. In addition, supportive treatments such as speech and voice therapy and hormone therapy are being covered.

Figures from the City and County of San Francisco, the first major US employer to explicitly cover medically necessary treatment for transgender transition in its healthcare plans, show that where historical data is limited, insurers tend to overestimate the cost of coverage.

According to the Human Rights Commission, three years after the plan’s benefit was implemented the city had paid out on only seven cases, as opposed to the expected 105. Meanwhile it had collected $4.3 million in additional premiums to offset projected transition-related claims, but paid out only $156,0003.

New economic study shows cost-effectiveness of treatment

Building a clearer picture

The availability and analysis of accurate data is vital for the proper functioning of the health insurance market. Since the number of transgender and gender nonconforming people who are presenting for healthcare services is rising, insurers need data to understand the topic, says Andrew Naugle, principal and healthcare management consultant at Milliman

Traditionally, the best way for insurers to try to predict the future is to look at past results, relying on historical utilisation and cost data to estimate the same for the future.

In the most simplistic terms, developing financial projections for insurance pricing requires three basic estimates: the number of people who will receive services, the scope of services and the cost of services. In this fast-developing area of transgender medical intervention, the industry struggles to estimate two if not all three of these key data elements. A legacy of under-reporting means that the historical record about the population is incomplete. Furthermore, a lack of benefit coverage for transgender health services has left a significant gap in the billing and claims data on which industry relies for its projections.

Notwithstanding these data challenges, the need to develop credible cost and utilisation projections remains. In time, as numbers increase and more patients are treated through their health insurers, the data will become richer. Until that happens, though, insurers wishing for greater understanding in this area will need the expert help of actuaries, statisticians and health data analysts to help fill in the gaps. Only by doing so will they be able to understand what the future holds.

A new analysis of data relating to transgender health indicates that covering health services related to gender confirmation is affordable and can actually be cost-effective when considering the impact on quality of life.

William Padula is assistant professor of health policy and management at Johns Hopkins Bloomberg School of Public Health. He led a recent study that looked at data from the 2011 National Transgender Discrimination Survey, which includes information on access to medical care and health outcomes, and also from the Healthcare Bluebook, which outlines the cost of medical services. Dr Padula concluded that paying for gender confirmation services is affordable because the price is not significantly higher than the cost of treatment for depression, substance abuse and HIV/AIDS, all of which are highly prevalent in transgender people not in a position to medically transition. Furthermore, the services are cost-effective when considered in the context of added years of quality of life for transgender people.

“Providing healthcare benefits to transgender people makes economic sense,” he said. “This is a small population of people and we can do them a great service without a huge financial impact on society.”4

Better data required in future

Dr Padula’s findings may lead to more affordable and available healthcare for those who are transgender, but more and better data is needed.

“Poor outcomes for transgender people worldwide could be improved by adopting a comprehensive approach ‘informed by high-quality data.’”

A recent academic paper in The Lancet, written by Dr Sari L Reisner, on the ‘Global Health Burden and Needs of the Transgender Population’ found that poor outcomes for transgender people worldwide could be improved by adopting a comprehensive approach “informed by high-quality data”.

At present, Dr Reisner stated, there are issues with the surveys currently available. These tend not to be standardised in either linguistic or geographical terms, which means that transgender health matters remain “understudied”.

“Measuring sex and gender dimensions in health research will contribute to understanding and ameliorating health inequities for all,” the paper found5.

Through analysing data on transgender health and accurately balancing the costs of treatment against those of leaving people untreated, it should be possible to put together cost-effective, valuable insurance cover for the transgender community.

This content was produced by FT², the advertising department of the Financial Times, in collaboration with Milliman.

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