Harvard Pilgrim Health Care Releases Report on Transgender Health Care

Harvard Pilgrim Health Care Foundation, through its Health Equity Roundtable initiative, 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."
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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: