Public Health Issue: Transgender Population

An estimated 700,000 people in the United States consider themselves to be transgender, according to an ABC News report. That’s bigger than the population of Seattle.

While the narrative surrounding this minority group -- whose self-identity does not conform unambiguously to conventional notions of male or female gender -- is becoming more inclusive, there are still many challenges facing this population, particularly in the health care field. Part of the mission of Creighton University’s Master of Public Health program is to provide the necessary skills to students to help overcome the challenges that minority populations encounter.

Here are five challenges associated with serving the transgender population, and what can be done to overcome them:

1. Insurance gaps

Insurance can be a tangled web of deductibles, premiums and eligibility requirements. Those challenges are compounded by state policy choices that affect health care coverage for the transgender community. A state’s stance on same-sex marriage and Medicaid expansion, for example, can leave the transgender community in a coverage gap. The impact of these policies reaches spouses and children in this minority population, too. 

The Affordable Care Act bans sex discrimination in most health care facilities, but the Kaiser Family Foundation, a non-profit that focuses on national health issues, says insurance for this population “will remain uneven across the country” because of the patchwork of state policies that still exists.

Nineteen percent of the transgender population lacks health insurance, compared to 15 percent of the general population, according to the National Transgender Discrimination Survey.

To help, health care providers can point transgender patients to a list of insurance providers on the Human Rights Campaign website.

2. Health care delivery hurdles

In some cases, health care delivery is hampered because providers have preconceived notions about the transgender population, and some some may lack education regarding the medical needs of the community.

A recent survey shows care was refused to 19 percent of the transgender population, another 28 percent reported harassment in a medical environment and 50 percent said they had to teach the provider about transgender care, according to the National Transgender Discrimination Survey.

Training and education can improve health care delivery within the transgender population. 

3. Health care facility challenges

A health care facility should strive for inclusion of every patient, but certain aspects may inadvertently exclude transgender people. For example, most registration forms ask patients whether they are male or female. Adding a "transgender" box to the form promotes inclusion of the transgender population.

Other facility-based changes that can promote inclusion of this minority group include providing access to a restroom or an assigned room that matches gender identity, rather than sex assigned at birth.

4. Incorrect billing information

Without gathering and noting proper information about transgender patients, an insurance company can receive improper information and deny claims based on such. This leaves transgender individuals to deal with cumbersome and confusing insurance claims others don’t have to deal with.

To alleviate this pressure, the Human Rights Campaign suggests training on coding practices and insurance hurdles typically faced by transgender patients.

5. Language barriers

Health care providers and transgender patients sometimes hit language barriers. What’s the proper way to address a transgender person? How should a health care provider discuss current and past relationships? The answer is to listen to the patients and take cues from them, says the Gay and Lesbian Medical Association’s guidelines for care.

Use the same language that transgender patients use to describe themselves and the people in their lives. Keep the dialogue professional, as with any client.

By taking courses such as those offered at Creighton’s Master of Public Health program, students are able to offer improved care for this under-served minority group.

© 2015 Wiley. All Rights Reserved.

ABC News
Kaiser Family Foundation
National Transgender Discrimination Survey
Human Rights Campaign
Human Rights Campaign
Gay and Lesbian Medical Association