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Harvard Pilgrim Health Care Foundation Report: March 2017

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
Phone: 603.315.4426
Email: Kimberly_Winn@HPHC.org

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