Gender Reassignment Treatment - Implications for corporate healthcare schemes
Historically, corporate private healthcare provision has excluded treatment for gender dysphoria. However, in 2016 a large banking group confirmed they had restructured their benefits to provide cover for such treatment. The recent adoption of similar stances by progressive organisations such as Facebook and Yahoo suggest that this corporate approach to gender identity is set to become the norm, fostered by an emerging culture of inclusion and diversity.
While this is a very positive approach, some argue that it could have implications for the corporate healthcare market beyond the simple inclusion of additional healthcare benefits. As such, it is important for employers to obtain expert input to ensure the benefit structures they provide are consistent with the level of support they plan to offer, as well as the overall message they wish to convey to employees.
What is gender dysphoria?
Gender dysphoria is the mismatch an individual feels as a result of the discrepancy experienced between their gender identity and the gender they were assigned at birth (GIRES, 2018, 2018). When this causes clinically significant distress or impairment it becomes known as gender dysphoria (NHS 2014). It is estimated that approximately
0.5 per cent -1.3 per cent of the UK population have some form of gender variance (Zucker, 2017).
Referral and treatment
At present, there are 8 Gender Identity Clinics (GICs) in the UK. Once referred to the relevant clinic, the individual will be assessed and will commence an individual treatment pathway suited to their needs.
The transitioning process is very individual and therefore it is difficult to provide indicative costs as these will be patient specific. However, on average, it is reasonable to assume that outpatient therapy (generally required pre-operatively) will cost around £2,000 to £5,000 per year while the gender confirmation surgery pathway can cost up to £100,000 depending on what is required. This does not include revision surgery or complications that may occur.
Inclusion of private cover for gender dysphoria could be said to defy the standard approach of excluding certain conditions, for example chronic, cosmetic and sexual conditions. Furthermore it could challenge the fundamental purpose of corporate private healthcare provision as a concept, historically exclusively designed to provide quick access to acute medical treatment in a bid to speed up employee return to work.
The adoption of this holistic approach suggests that the ethos of private corporate healthcare is evolving to support benefits for a wide range of physical, emotional, sexual and mental health conditions. While they are not comparable, supporting gender confirmation treatment may impact the provision of other traditionally excluded conditions. For example, assisted reproduction. It is well recognised that assisted reproduction provision on the NHS is underfunded and oversubscribed, yet this area of unmet need is not generally funded within the corporate healthcare market.
Despite this oversubscription, in August 2018, the NHS has been advised that they must extend their offering of fertility treatment to encompass transgender patients. If employers are providing gender confirmation services it could be suggested that they are bound to offer fertility support to individuals who have transitioned. As such, it could be argued that this should be extended to all employees.
It is important for employers wishing to fund treatment for gender dysphoria to be aware of the possible requirements for ongoing treatment in this patient group. This could range from psychological support to treatment of complications arising from hormone therapy, or individuals requesting revision surgeries as a result of new technology with associated improved cosmetic outcomes.
In addition to treatment considerations, it is essential to clearly delineate the level of cover available under the benefit for gender dysphoria. This includes clear guidance surrounding underwriting, any operational constraints to NHS transfers and family cover. The regret rate for gender confirmation surgery is estimated at 2-4 per cent so this must be considered when determining if revision surgery to restore biological gender would be eligible, especially as this is not funded by the NHS (NHS England 2018).
It is likely that private access to gender dysphoria treatment will continue to become readily available within the corporate healthcare market. This is a positive step which reflects the progress being made towards the inclusion and involvement of people with gender dysphoria.
The addition of gender confirmation benefits to corporate healthcare plans marks a milestone in the shift of the industry towards a holistic approach to employees, suggesting the emphasis is no longer being placed exclusively on medical necessity and disease. As such, it is important for employers to obtain expert input to ensure the benefit structures they provide are consistent with the level of support they plan to offer, as well as the overall message they wish to convey to employees.
This article was provided by Healix Health Services.
Gender Identity Research and Education Society (2018) Terminology https://www.gires.org.uk/
Gender Identity Development Service (2018) Appointment waiting times. The Tavistock and Portman NHS Foundation Trust.
Tim C. van de Grift, Els Elaut, Susanne C. Cerwenka, Peggy T. Cohen-Kettenis & Baudewijntje P. C. Kreukels (2018) Surgical Satisfaction, Quality of Life, and Their Association After Gender-Affirming Surgery: A Follow-up Study, Journal of Sex & Marital Therapy, 44:2, 138-148
NHS (2007). NHS funding processes and waiting times for adult service users, Department of Health, England.
NHS England. Interim Gender Dysphoria Protocol and Service 2013/14. NHS England, UK
Nuno N, Elizabeth P, Allan T, Ian R. The RaRE Research Report: LGB & T Mental Health – Risc and Resilience Explored. London, England: PACE – Project for Advocacy Counselling and Education; 2015
Torjesen I. (2018) Trans health needs more and better services: increasing capacity, expertise, and integration. British Medical Journal: 362.
White Hughto JM, Reisner SL, Pachankis JE. Transgender Stigma and Health: A Critical Review of Stigma Determinants, Mechanisms, and Interventions. Social science & medicine (1982). 2015;147:222—231.
Zucker, Kenneth. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual health. 14. 10.1071/SH17067.
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