WELLESLEY, Mass.—Harvard Pilgrim Health Care Foundation, through its Health Equity Roundtable initiative, today released a far-reaching report that identifies numerous areas in which the health care system in Greater Boston fails the needs of transgender individuals.
The report, which is based on a roundtable discussion that included transgender men, women and youth, and parents, advocates and clinicians, found that there exists 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 even basic 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. In it, participants described long wait times to access doctors and other clinicians with experience in caring for transgender people—an issue that was identified as especially problematic for transgender children who must begin puberty-blocking drugs within a few months of achieving certain growth milestones. With the wait to see a competent pediatric endocrinologist potentially in excess of a year, the inability to access care in a timely manner can have lifelong negative effects on the patient.
“We launched this Roundtable program to help Harvard Pilgrim and the health care industry tackle some of the important health disparities of our day,” said Dowd, who worked with other senior leaders at Harvard Pilgrim on this project. “By coming together and talking face-to-face in a safe environment, we were able to ask questions and gather information from those individuals most directly impacted. We hope that by sharing this information with other health care professionals, we can begin to get a better understanding of the issues and create positive change and greater equity for all.”
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, located at Boston Medical Center, who provide gender affirming surgical services, and currently those services are only available for transgender women (individuals transitioning from male to female.)
Participants also highlighted a need for more robust research into health issues important to members of the trans community. They cited a lack of knowledge about potential interactions between drugs used in hormone treatments and those used to treat other health conditions, such as heart disease, cancer and diabetes, and a lack of research on issues affecting aging trans men and women.
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 transhealth.
- Encouraging provider networks to list trans-competent providers.
- Developing acuity indictors 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.
About The Harvard Pilgrim Health Care Foundation
Created in 1980, The Harvard Pilgrim Health Care Foundation supports Harvard Pilgrim’s mission to improve the quality and value of health care for the people and communities we serve. The Harvard Pilgrim Foundation provides the tools, training and leadership to help build healthy communities throughout Connecticut, Maine, Massachusetts, and New Hampshire. In 2016, the Harvard Pilgrim Foundation awarded more than $2.4 million in grants to more than 900 nonprofit organizations in the region. Since its inception in 1980, the Foundation has awarded $140 million in funds and resources throughout the four states. For more information, please visit www.harvardpilgrim.org/foundation.
About Harvard Pilgrim Health Care
Harvard Pilgrim is a not-for-profit health services company that, along with its subsidiaries, is improving the well-being of its 2.7 million customers. Harvard Pilgrim’s flagship health plans in New England provide health coverage to 1.3 million members, while another 1.4 million individuals are served through Health Plans, Inc., a subsidiary that provides integrated care management, health coaching and plan administration solutions to self-funded employers nationwide. Founded in 1969, Harvard Pilgrim has built its reputation on innovation and collaboration with a goal of lowering health care costs, improving care and enhancing the overall member experience. It is known for its excellent clinical programs, customer service, health improvement strategies and innovative tools that offer consumers greater transparency and empower them to make better decisions about their health care. Harvard Pilgrim is home to the Harvard Pilgrim Health Care Institute, a unique collaboration with Harvard Medical School. As Harvard Medical School’s Department of Population Medicine, the Institute is the only appointing department of a U.S. medical school housed within a health plan. Funded primarily through external government and private sources, it provides critical information to all levels of our health care system on issues affecting population health and health care delivery. Harvard Pilgrim is consistently among America’s highest-rated health plans according to an annual ranking of the nation’s best health plans by the National Committee for Quality Assurance (NCQA)*.
*Harvard Pilgrim Health Care (private HMO/POS and PPO plans) and Harvard Pilgrim Health Care of New England (private HMO/POS plans) have been rated 4.5 out of 5 in NCQA’s Private Health Insurance Plan Ratings 2016-17. NCQA’s Private Health Insurance Plan Ratings 2015-16. NCQA’s Private Health Insurance Plan Rankings, 2011-15, HMO/POS/PPO.
[From a News Release]