By Dr. Antimony Deor<\/p>\n
This year might be the year that new Medicare Item Numbers are created specifically for\u00a0gender-affirming surgeries. This move would be a crucial step forward for both healthcare\u00a0workers and trans and gender-diverse people across Australia.<\/p>\n
Every medical service, procedure, treatment, and medication covered under the Medicare\u00a0system has a unique five-digit number assigned to it. These are known as Medicare Item\u00a0Numbers and are akin to a catchy nickname for a procedure. \u201cComplex laparoscopic\u00a0hysterectomy with bilateral salpingo-oophorectomy\u201d becomes simply \u201c35753\u201d. Item\u00a0numbers standardise terminology across Australia, allow easy identification, and facilitate\u00a0the efficient collection and analysis of health data.<\/p>\n
Everything with an item number also has a price set by Medicare. This is called the\u00a0Medicare Benefit Schedule Fee (or MBS fee) and represents the standard payment a\u00a0doctor will receive when they perform a particular procedure. MBS fees allow patients in\u00a0the private system to compare doctors, and doctors to know exactly how much money they\u00a0will receive from Medicare.<\/p>\n
However, gender-affirming surgeries do not currently have their own unique item numbers.\u00a0Instead, surgeons use numbers that are close enough or approximate to the kind of surgery\u00a0they are actually doing. A surgeon performing top surgery might use the item number for a\u00a0double mastectomy, for example, even though cis women who get mastectomies do not\u00a0usually request their chest be contoured to a masculine shape. This means that doctors\u00a0are not reporting the right data, are not receiving the right remuneration, and patients are\u00a0picking up the fee.<\/p>\n
Some procedures cannot be described by existing item numbers and fall outside the\u00a0Medicare framework altogether. Neither Medicare nor private health insurance pays any\u00a0benefits towards these surgeries, leaving the patient to cover the entire cost themselves.\u00a0The resulting fee can be tens of thousands of dollars, which means trans people must\u00a0save for years, forgo other financial goals, or go without healthcare.<\/p>\n
The proposed additional item numbers would also cover some GP, sexual health, and\u00a0psychiatric consultations specifically relating to gender-affirming care. A separate\u00a0application has been made to the Pharmaceutical Benefits Scheme Committee to allow\u00a0hormones to be prescribed in the case of gender incongruence.<\/p>\n
The consultation process for this application gathered responses from trans people and\u00a0health bodies citing the high costs of surgeries and the risks to practitioners in reporting\u00a0inaccurate item numbers, as well as the effect this measure would have on reducing\u00a0stigma associated with gender-affirming care. Opponents of the application argued that\u00a0surgery can result in loss of sexual function and fertility, patients may feel regret, gender\u00a0incongruence is not a genuine condition, and patients should be directed towards\u00a0psychological therapy instead.<\/p>\n
The proposed new Item Numbers would only be applicable to procedures performed on\u00a0adults between the ages of 18 and 50. The application will be heard by several committees\u00a0throughout 2024 before advice is finally presented to the government.<\/p>\n","protected":false},"excerpt":{"rendered":"
By Dr. Antimony Deor This year might be the year that new Medicare Item Numbers are created specifically for\u00a0gender-affirming surgeries. This move would be a crucial step forward for both …<\/p>\n","protected":false},"author":21,"featured_media":229537,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[11206,11205],"tags":[1809,21623,42277],"class_list":["post-229534","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-national-news","category-news","tag-australia","tag-medicare","tag-trans-healthcare"],"acf":[],"yoast_head":"\n