Harvard Pilgrim Health Care Foundation (Wellesley, MA)
Harvard Pilgrim Health Care Foundation, through its Health Equity Roundtable initiative, released a report that identifies numerous areas in which the health care system in Greater Boston fails the needs of transgender individuals. It found a serious shortage of providers who can sensitively and competently provide care—even routine care—to transgender patients. Health care professionals were seen by participants as lacking knowledge about trans health issues, and clinicians themselves reported a lack of training across all professional disciplines.
The report was authored by Shani Dowd, Director of the Health Equity Roundtable, a program of the Harvard Pilgrim Health Care Foundation, and an Assistant Clinical Professor of Psychiatry at Boston University Medical School.
Participants reported being treated poorly by both clinicians and ancillary staff who did not understand their needs, and those interactions made them wary of seeking care. They also reported that getting referrals for care was difficult, as few providers knew which health care organizations could provide services. Ethnic minority transgender people were seen as being at a significant disadvantage due to factors including racism, poverty, language barriers, and lack of social support.
The report also found that there is a wide variation in health insurance coverage for transgender care and how out-of-network coverage is managed. Out-of-network coverage was seen as especially important as currently there are only two surgeons in New England who provide gender affirming surgical services, and currently those services are only available for transgender women (individuals transitioning from male to female.)
The report offers a host of recommendations to improve the system, including:
- Integrating basic knowledge of transgender health needs into medical, nursing, and other clinical training
- Educating practicing clinicians in the basics of trans health
- Encouraging provider networks to list trans-competent providers
- Developing acuity indicators to accompany the diagnosis of gender dysphoria to permit tracking and quality assessment of patients all along the gender continuum
- Developing protocols for in-patient settings to safely accommodate transgender, gender queer, and non-binary patients
The foundation expects to hold two additional roundtables on transgender health care throughout the region in 2017.
Contact: Kim Winn
Maine Health Access Foundation (Augusta)
A new report released by the Maine Health Access Foundation (MeHAF) and the University of Southern Maine, Mental Health Status and Access to Health Care Service for Adults in Maine, describes how adults 18 and older in Maine who report depression and poor mental health have many barriers to getting health care. These results have important implications for planning in a time when major changes in health insurance coverage are expected.
Roughly 12 percent of Maine adults reported experiencing two weeks or more of bad mental health days in the past month and one in 10 had probable depression at the time they were surveyed. People in both groups were significantly less likely to receive needed health care due to cost and were more likely to delay care. These adults with poorer mental health status also were more likely to report paying medical bills over time than were adults with better mental health status. Those with probable depression were much more likely to have health insurance through MaineCare, Medicare, or to be uninsured than those without depression.
Some bright spots in Maine include broad implementation of integrated primary care and mental health, within both patient centered medical homes and behavioral health homes, two initiatives developed under a series of federal grants, including the 2013 State Innovation Model grant awarded to Maine DHHS by the Center for Medicare and Medicaid Innovation. MeHAF dedicated nearly $10 million over a decade to advance integrated care.
Mental Health Status and Access to Health Care Service for Adults in Maine highlights information from the ongoing federal/state public health survey, the Behavioral Risk Factor Surveillance System (BRFSS). MeHAF support allows inclusion of additional questions about access to insurance and health care services in the state’s BRFSS, which surveys a random sample of Maine people throughout the year. Results from the compiled 2012, 2013, and 2014 surveys are included in the report.
Contact: Barbara Leonard
Phone: 207.620.8266, x102
Mat-Su Health Foundation (Wasilla, AK)
The Mat-Su Health Foundation has published the findings of its 2016 Community Health Needs Assessment (CHNA). The report, “Health is Where We Live, Learn, Work and Play,” identified the top factors that affect the health of local residents: transportation; social connection and support; income; education and information; and housing.
Examples of how where we live, learn, work, and play impacts our health include whether we have access to medical care (transportation) and can afford to pay for it (income), whether we feel safe (housing), whether we have access to education, including early childhood education (education), whether we have knowledge of resources available to us (information), and whether we experience a strong sense of community (social connection and support).
The next step is for the foundation to work with its partner, Mat-Su Regional Medical Center, to draft an implementation plan based on the four goals identified by the assessment:
- Transportation: All Mat-Su residents have transportation to work, health care appointments, school and community activities, and other opportunities that affect the quality of their lives.
- Social connection and support: Mat-Su is a community where all residents feel supported by and connected to family, friends, neighbors, and the broader community.
- Income and housing: Mat-Su has economic opportunities that allow residents to have a level of income that supports a healthy lifestyle and provides for safe and affordable housing.
- Education and information: Mat-Su is a community that supports education for residents and provides full access to information needed to promote health, wellness, and quality of life.
Contributors include Alaska Mental Health Trust, CCS Early Learning, Chickaloon Village, Identity Alaska, Knik Tribal Council, Mat-Su Health Services, Mat-Su Regional Medical Center, Sunshine Community Health Center.
The full 2016 Mat-Su Community Health Needs Assessment is at www.healthmatsu.org.