The landscape of Medicare policies for gender-affirming surgeries in Canada: an environmental scan

Dave Gwun; Brennan Snow; Emery Potter; Rachel Loewen Walker; Alexandra L Millman; Yonah Krakowsky; Gianni R Lorello; Janice Du Mont; Lucy C Barker; Percy Lezard; Marudan Sivagurunathan; David R Urbach; Kathleen Armstrong

doi:10.1186/s12913-024-11361-w

The landscape of Medicare policies for gender-affirming surgeries in Canada: an environmental scan

BMC Health Serv Res. 2024 Aug 10;24(1):916. doi: 10.1186/s12913-024-11361-w.

Authors

Dave Gwun^#¹, Brennan Snow^#², Emery Potter^{2

3}, Rachel Loewen Walker⁴, Alexandra L Millman^{5

6}, Yonah Krakowsky^{5

6}, Gianni R Lorello^{2

7

8

9}, Janice Du Mont^{2

10}, Lucy C Barker^{2

11}, Percy Lezard¹², Marudan Sivagurunathan², David R Urbach^{6

13}, Kathleen Armstrong^{14

15

16}

Affiliations

¹ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. [email protected].
² Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
³ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
⁴ Department of Women's and Gender Studies and Political Studies, University of Saskatchewan, Saskatoon, SK, Canada.
⁵ Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
⁶ Transition Related Surgery Program, Women's College Hospital, Toronto, ON, Canada.
⁷ Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
⁸ Department of Anesthesiology and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada.
⁹ The Wilson Centre, Toronto General Hospital, Toronto, ON, Canada.
¹⁰ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹¹ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
¹² Department of Indigenous Studies, Law and Social Justice, Wilfrid Laurier University, Waterloo, ON, Canada.
¹³ Department of Surgery, Women's College Hospital, Toronto, ON, Canada.
¹⁴ Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. [email protected].
¹⁵ Transition Related Surgery Program, Women's College Hospital, Toronto, ON, Canada. [email protected].
¹⁶ Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. [email protected].

^# Contributed equally.

Abstract

Background: Many studies have described barriers to gender-affirming surgery (GAS) in Canada; however, few have explored why these barriers persist. To address this knowledge gap, we sought to describe documents related to public health insurance (Medicare) for GAS to identify the types of procedures covered, variations in coverage across provinces and territories, and changes in policy over time.

Methods: We conducted a descriptive cross-sectional study using an environmental scan approach. We queried 23 government websites, the Google search engine, and an online legal database between July 2022 and April 2024 to gather gray literature documents related to GAS and Medicare. Variables from relevant documents were compiled to create a present, at-glance overview of GAS Medicare coverage for all provinces and territories and a timeline of policy changes across Canada. RESULTS: Eight provinces and three territories had documents or websites related to GAS Medicare coverage (85%). We identified 15 GAS procedures that were covered variably across Canada. Yukon (n = 14) covered the most types of GAS, while Quebec and Saskatchewan covered the least (n = 6). Mastectomy and genital surgeries were covered across Canada, but other GAS were rarely covered. Five provinces and territories provided coverage for travel-related costs. Our GAS Medicare timeline showed differential expansion of GAS coverage in Canada over the last 25 years. CONCLUSIONS : We provide previously unreported information regarding GAS Medicare coverage in Canada. We hope our findings will help patients and healthcare providers navigate a complicated public healthcare system. We also highlight barriers within GAS Medicare documents and make recommendations to alleviate those barriers.

Keywords: 2S-LGBTQ + health; Access to care; Insurance policy; Resource.

MeSH terms

Canada
Cross-Sectional Studies
Female
Health Policy
Humans
Insurance Coverage / statistics & numerical data
Male
Medicare / economics
National Health Programs
Sex Reassignment Surgery* / economics