Online Program

Socio-economic determinants of unmet need for gender-confirming healthcare

Tuesday, November 5, 2013 : 11:15 a.m. - 11:30 a.m.

Janelle Downing, MS, Health Services and Policy Analysis, University of California, Berkeley, Berkeley, CA
Objective: To examine the extent to which income and health insurance determine unmet need for gender-confirming care for transgender and gender non-conforming adults. Methods: We used data collected from the National Transgender Discrimination Survey (n=6,456), a cross-sectional, non-probability survey of adults who self-identified as transgender or gender non-conforming. The sample was restricted to those who had desired or had received counseling, hormones, top surgery, or other gender-confirming surgeries. We used logistic regression models to explore health insurance and income to needs ratio as predictors of unmet need for gender-confirming healthcare. We adjusted for age, education, and perceived visual conformity, then stratified by gender identity. Results: Those without insurance are less likely to have received counseling (odds ratio [OR]=0.698) and top surgery (OR=0.801) compared to those with private insurance. The poor and near poor have a lower odds of receiving top surgery (OR=0.673-0.811) and other surgeries (OR=0.703- 0.742) compared to those living at more than 400% above the federal poverty line (FPL). Stratifying for gender identity generated differential effects in experiences of unmet need, particularly for hormones and top surgeries. Female-to-male (FTM) adults who lived below the poverty line were more likely to have an unmet need for hormones. Conclusion: Income and private health insurance are strong predictors of unmet need for gender-confirming healthcare. These barriers to accessing health services may continue to perpetuate and even exacerbate the psychological and somatic health of transgender people.

Learning Areas:

Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Demonstrate the extent to which poverty is a barrier to receiving gender-confirming healthcare

Keyword(s): Access to Health Care, Economic Analysis

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a doctoral student at Health Services and Policy Analysis. My research interests are focused on health systems and economic barriers to receiving healthcare in gender and sexual minorities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.