Trauma, homelessness afflict gender affirming care patients at higher rates

A survey of patients receiving gender affirming care shows that commercial insurance pays for most of their treatments, they receive less care in the South than other parts of the U.S. and they deal with disproportionate levels of housing insecurity and trauma compared to others, according to a new study by researchers at the Colorado School of Public Health and the University of Colorado Anschutz Medical Campus.

The study, using data provided by Kythera Labs, a healthcare clearinghouse, examined millions of insurance claims by patients undergoing gender affirming care (GA) and those not. It also looked at social determinants of healthcare (SDOH), non-medical factors which affect a person’s quality of life.

The study was published today in the Journal of General Internal Medicine.

It showed that commercial insurance covered 72.8% of GA claims followed by Medicaid at 17.2 %, other insurance at 6.6% and Medicare at 3.5%. GA patients incurred more claims across all insurance and age groups, about 87% more overall.

GA patients had the smallest number of claims filed in the South – 21.9% vs. 31.1%. The West had the highest numbers at 26.7% vs. 22%. The Northeast was next with 26.4% vs. 23.2% and the Midwest was 24.3% vs. 21.4%.

“The relatively smaller proportion of claims filed in the South could represent lower proportions of GA persons living there and/or less access to gender-affirming care,” said the study’s lead author, Jason Brian Gibbons, PhD, associate professor of health systems, management and policy at the Colorado School of Public Health.

Gibbons said he was surprised to how many GA patients were covered by commercial insurance compared to Medicaid and Medicare.

The study also measured SDOH which uses categories for issues facing patients. In the case of GA patients, the categories “problems related to housing and economic circumstances” and “problems related to upbringing” were the most commonly used.

“The probability of SDOH diagnosis was higher for GA patients than non-GA patients for all major SDOH categories,” Gibbons said.

The study, he said, can help policy makers create `tailored support’ for GA patients.

“I think we need to look into what kind of social supports GA people are getting,” he said. “They need transportation support, child care support. Some are facing trauma like sexual violence. There are massive differences in the social vulnerabilities they face.”

About the University of Colorado Anschutz Medical Campus

The University of Colorado Anschutz Medical Campus is a world-class medical destination at the forefront of transformative science, medicine, education and patient care. The campus encompasses the University of Colorado health professional schools, more than 60 centers and institutes and two nationally ranked independent hospitals - UCHealth University of Colorado Hospital and Children's Hospital Colorado – which see more than two million adult and pediatric patient visits yearly. Innovative, interconnected and highly collaborative, the CU Anschutz Medical Campus delivers life-changing treatments, patient care and professional training and conducts world-renowned research fueled by $910 million in annual research funding, including $757 million in sponsored awards and $153 million in philanthropic gifts.