Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost-Effectiveness Analysis

Journal of General Internal Medicine

Volumn 31, Issue 4, 2016, Pages 394-401

  Padula, William V ^a   Heru, Shiona ^b   Campbell, Jonathan D ^c  

^a JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH   (United States)

^b MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH   (United States)

^c UNIVERSITY OF COLORADO   (United States)

Author keywords

budget impact analysis; cost effectiveness analysis; health insurance coverage; health law; preventive care; transgender health

Indexed keywords

ARTICLE; COST EFFECTIVENESS ANALYSIS; DEPRESSION; DRUG ABUSE; HEALTH CARE COST; HEALTH INSURANCE; HEALTH SERVICE; HIDDEN MARKOV MODEL; HORMONE SUBSTITUTION; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; QUALITY ADJUSTED LIFE YEAR; SEX REASSIGNMENT; SUICIDAL BEHAVIOR; TRANSGENDER; UNITED STATES; COST BENEFIT ANALYSIS; ECONOMICS; EPIDEMIOLOGY; FEMALE; INSURANCE; MALE; MARKOV CHAIN; PROCEDURES; SOCIAL CHANGE; SOCIAL NORM; STATISTICS AND NUMERICAL DATA;

COST-BENEFIT ANALYSIS; FEMALE; HUMANS; INSURANCE COVERAGE; MALE; MARKOV CHAINS; SOCIAL CHANGE; SOCIAL NORMS; TRANSGENDER PERSONS; UNITED STATES;

EID: 84944708011     PISSN: 08848734     EISSN: 15251497     Source Type: Journal    
DOI: 10.1007/s11606-015-3529-6     Document Type: Article

References (45)

1. Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at Every Turn: a Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011.
2. Gorton RN. Transgender Medicine. San Francisco: Lyon-Martin Health Services; 2010.
3. Coleman E, Bockting W, Bozter M, Cohen-Kettenis P, DeCurpere G, Feldman J, et al. Standards of care for health of transsexual, transgender, and gender nonconforming people. Int J Transgenderism. 2011;13(4):165–232.
4. Departmental Appeals Board Appellate Division. Transsexual Surgery. Washington, D.C.2014. Report No.: Docket No. A-13-87, Decision No. 2576.
5. Notice of Proposed Regulations: MassHealth. The Commonwealth of Massachusetts. Executive Office of Health and Human Services. Public Notice, 130 CMR 405.000, 130 CMR 406.000, 130 CMR 410.00-AOH, 130 CMR 410.000-COH, 130 CMR 415.000, 130 CMR 423.000, 130 CMR 424.000, 130 CMR 433.000 (October 8, 2014); Public Notice, 130 CMR 450.000 (September 12, 2014).
6. Daniel H, Butkus R. Lesbian, gay, bisexual, and transgender health disparities: executive summary of a policy position paper from the American College of Physicians. Ann Intern Med. 2015. doi:10.7326/m14-2482.
7. Friedman K, Robinson A, Fidas D, Cooper L, Leibowitz E. In: Fidas DGJ, Wilson A, eds. Transgender-Inclusive Healthcare Coverage and the Corporate Equality Index. Washington, D.C: Human Rights Campaign Foundation; 2013.
8. Walsham K. De-gendering health insurance: a case for a federal insurance nondiscrimination act. 24 Hastings Women's Law J. 2013 Winter;197:12.
9. Macy v. Department of Justice, U.S. Equal Employment Opportunity Commission, Appeal No. 0120120821, (2012 Apr 20).
10. Primary Care Protocol for Transgender Patient Care. San Francisco: Center of Excellence for Transgender Health, University of California, Department of Family and Community Medicine; 2011 Apr.
11. Horton M. Cost of Transgender Health Benefits. Out and Equal Workplace Summit. 2008 Sep; Retrieved from: http://www.tgender.net/taw/thbcost.html. Accessed on 17 Sept 2015.
12. Herman JL. The Cost of Employment Discrimination against Transgender Residents of Massachusetts. The Williams Institute, UCLA School of Law. 2011.
13. Lundström B. Gender Dysphoria: a Social-Psychiatric Follow-Up Study of 31 Cases not Accepted for Sex Reassignment. Gothenburg, Sweden: University of Gothenburg; 1981.
14. Kuiper B, Cohen-Kettenis P. Sex reassignment surgery: a study of 141 Dutch transsexuals. Arch Sex Behav. 1988;17(5):439–57.
15. Lundstrom B, Pauly I, Walinder J. Outcome of sex reassignment surgery. Acta Psychiatr Scand. 1984;70(4):289–94.
16. Lipscomb J, Weinstein MC, Torrance GW. Time preference. In: Gold M, Siegel JE, Russell LB, Weinstein MC, eds. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press; 1996:214–35.
17. Beck JR, Pauker SG. The Markov process in medical prognosis. Med Decis Mak. 1983;3:419–58.
18. Luce B, Manning WG, Siegel JE, Lipscomb J. Estimating costs in cost-effectiveness analysis. In: Gold M, Siegel JE, Russell LB, Weinstein MC, eds. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press; 1996:176–213.
19. Healthcare Bluebook. Brentwood, TN: CAREOperative; 2015.
20. Sullivan PW, Ghushchyan V. Preference-based EQ-5D index scores for chronic conditions in the United States. Med Decis Mak. 2006;26:410–20.
21. Gorton RN, Buth J, Spade D. Medical Therapy and Health Maintenance for Transgender Men: A Guide for Health Care Profiders. San Francisco: Lyon-Martin Health Services; 2005.
22. Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: Final data for 2005. National Vital Statistics Reports; vol 56 no 10. Hyattsville, MD: National Center for Health Statistics; 2008.
23. Cochran SD, Mays VM. Mortality risks among persons reporting same-sex sexual partners: evidence from the 2008 General Social Survey-National Death Index data set. Am J Public Health. 2015;105(2):358–64. doi:10.2105/ajph.2014.301974.
24. Dhejne C, Lichtenstein P, Boman M, Johansson AL, Langstrom N, Landen M. Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PLoS One. 2011;6(2), e16885. doi:10.1371/journal.pone.0016885.
25. Lombardi E. Enhancing transgender health care. Am J Public Health. 2001;91(6):869–72.
26. Bishai D, Sindelar J, Ricketts EP, Huettner S, Cornelius L, Lloyd JJ, et al. Willingness to pay for drug rehabilitation: implications for cost recovery. J Health Econ. 2008;27(4):959–72. doi:10.1016/j.jhealeco.2007.11.007.
27. Czernin S, Vogel M, Fluckiger M, Muheim F, Bourgnon JC, Reichelt M, et al. Cost of attempted suicide: a retrospective study of extent and associated factors. Swiss Med Wkly. 2012;142:w13648. doi:10.4414/smw.2012.13648.
28. Padula WV, Allen RR, Nair KV. Determining the cost of obesity and its common comorbidities from a commercial claims database. Clin Obes. 2014;4(1):53–8.
29. Walensky RP, Sax PE, Nakamura YM, Weinstein MC, Pei PP, Freedberg KA, et al. Economic savings versus health losses: the cost-effectiveness of generic antiretroviral therapy in the United States. Ann Intern Med. 2013;158(2):84–92. doi:10.7326/0003-4819-158-2-201301150-00002.
30. Coffin PO, Sullivan SD. Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal. Ann Intern Med. 2013;158(1):1–9. doi:10.7326/0003-4819-158-1-201301010-00003.
31. Wu AW, Jacobson KL, Frick KD, Clark R, Revicki DA, Freedberg KA, et al. Validity and responsiveness of the Euroqol as a measure of health-related quality of life in people enrolled in an AIDS clinical trial. Qual Life Res. 2002;11(3):273–82.
32. Padula WV, Mishra MK, Makic MB, Sullivan PW. Improving the quality of pressure ulcer care with prevention: a cost-effectiveness analysis. Med Care. 2011;49(4):385–92.
33. Sullivan SD, Mauskopf JA, Augustovski F, Jaime Caro J, Lee KM, Minchin M, et al. Budget impact analysis-principles of good practice: report of the ISPOR 2012 budget impact analysis good practice II task force. Value Health. 2014;17(1):5–14. doi:10.1016/j.jval.2013.08.2291.
34. Reaves ND. A model of effective health policy: the 1983 Orphan Drug Act. J Health Soc Policy. 2003;17(4):61–71.
35. Strausbaugh SD, Davis PB. Cystic fibrosis: a review of epidemiology and pathobiology. Clin Chest Med. 2007;28(2):279–88. doi:10.1016/j.ccm.2007.02.011.
36. Whiting P, Al M, Burgers L, Westwood M, Ryder S, Hoogendoorn M, et al. Ivacaftor for the treatment of patients with cystic fibrosis and the G551D mutation: a systematic review and cost-effectiveness analysis. Health Technol Assess (Winchester, England). 2014;18(18):1–106. doi:10.3310/hta18180.
37. Schultz NM, Malone DC. PSY14 - a probabilistic budget impact analysis of cystic fibrosis therapy on health plan pharmacy budgets. Value Health. 2014;17(3):A226.
38. Massachusetts General Law 118E §64. 2012.
39. Rosenbaum S. Insurance discrimination on the basis of health status: an overview of discrimination practices. Law J Med Ethics. 2009;37:103–9.
40. Coleman SC, et al. Hidden Costs, Value Lost: Uninsurance in America. Washington, DC: Institute of Medicine; 2003.
41. Meyer W III, Bockting WO, Cohen-Kettenis P, Coleman E, Diceglie D, Devor H, et al. The Harry Benjamin international gender dysphoria association's standards of care for gender identity disorders, sixth version. J Psychol Hum Sex. 2002;13(1):1–30.
42. de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014;134(4):696–704. doi:10.1542/peds.2013-2958.
43. Lyons T, Shannon K, Pierre L, Small W, Krusi A, Kerr T. A qualitative study of transgender individuals' experiences in residential addiction treatment settings: stigma and inclusivity. Subst Abuse Treat Prev Policy. 2015;10:17. doi:10.1186/s13011-015-0015-4.
44. Nexon D, Ubl SJ. Implicaitons of health reform for the medical technology industry. Health Aff (Millwood). 2010;29(7):1325–29.
45. Mass. Legis. Serv. Ch. 151 (H.B. 6100) (Ch. 118G §1). 1996.