旅行距离和国家对性别确认手术的准入
Thomas Johnstone1, Kometh Thawanyarat2, Gina R Eggert3
1Stanford University School of Medicine, Stanford, CA.
Surgery
|October 15, 2023
概括
由于护理分配不平等,许多人前往进行性别确认手术. 患者旅行的中位数为191英里,其中36%的人出国进行这些必要的手术.
科学领域:
- 医学地理 医学地理
- 医疗保健服务研究 医疗服务研究
- 健康的社会经济决定因素
背景情况:
- 在美国,性别确认手术的准入受资源分配,州法规和医生可用性限制.
- 许多患者必须走很长的路程才能获得性别确认的外科护理.
- 在获得医疗保健的地理差异显著影响跨性别和性别不符合的个人.
研究的目的:
- 根据手术类型和患者的来源量化性别确认手术的旅行距离.
- 确定影响性别肯定手术州外旅行的因素.
- 为了分析可负担医疗法案扩大后的旅行距离的趋势.
主要方法:
- 在接受性别确认手术的患者中利用了Optum Clinformatics数据中心 (2003-2020年).
- 使用谷歌地图距离矩阵API根据患者和提供者的邮政编码计算出旅行距离.
- 采用多变量回归分析来确定旅行距离和州外旅行的预测因素.
主要成果:
- 该研究包括1735名患者,平均旅行距离为191英里 (平均391.5英里).
- 36.0%的患者出国旅行,所有来自五个州的患者都出国旅行.
- 生殖器外科手术和拥有更广泛供应商选择的保险预测州外旅行;2014年ACA扩张后旅行距离减少.
结论:
- 相当大的旅行距离凸显了性别肯定手术的地理差异.
- 国家法律和保险覆盖范围影响患者在性别确认程序的旅行.
- 解决这些障碍对于改善平等获得性别肯定性外科护理至关重要.
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