今日吃瓜

By Dr. Antimony Deor

This year might be the year that new Medicare Item Numbers are created specifically for聽gender-affirming surgeries. This move would be a crucial step forward for both healthcare聽workers and trans and gender-diverse people across Australia.

Every medical service, procedure, treatment, and medication covered under the Medicare聽system has a unique five-digit number assigned to it. These are known as Medicare Item聽Numbers and are akin to a catchy nickname for a procedure. 鈥淐omplex laparoscopic聽hysterectomy with bilateral salpingo-oophorectomy鈥� becomes simply 鈥�35753鈥�. Item聽numbers standardise terminology across Australia, allow easy identification, and facilitate聽the efficient collection and analysis of health data.

Everything with an item number also has a price set by Medicare. This is called the聽Medicare Benefit Schedule Fee (or MBS fee) and represents the standard payment a聽doctor will receive when they perform a particular procedure. MBS fees allow patients in聽the private system to compare doctors, and doctors to know exactly how much money they聽will receive from Medicare.

However, gender-affirming surgeries do not currently have their own unique item numbers.聽Instead, surgeons use numbers that are close enough or approximate to the kind of surgery聽they are actually doing. A surgeon performing top surgery might use the item number for a聽double mastectomy, for example, even though cis women who get mastectomies do not聽usually request their chest be contoured to a masculine shape. This means that doctors聽are not reporting the right data, are not receiving the right remuneration, and patients are聽picking up the fee.

Some procedures cannot be described by existing item numbers and fall outside the聽Medicare framework altogether. Neither Medicare nor private health insurance pays any聽benefits towards these surgeries, leaving the patient to cover the entire cost themselves.聽The resulting fee can be tens of thousands of dollars, which means trans people must聽save for years, forgo other financial goals, or go without healthcare.

The proposed additional item numbers would also cover some GP, sexual health, and聽psychiatric consultations specifically relating to gender-affirming care. A separate聽application has been made to the Pharmaceutical Benefits Scheme Committee to allow聽hormones to be prescribed in the case of gender incongruence.

The consultation process for this application gathered responses from trans people and聽health bodies citing the high costs of surgeries and the risks to practitioners in reporting聽inaccurate item numbers, as well as the effect this measure would have on reducing聽stigma associated with gender-affirming care. Opponents of the application argued that聽surgery can result in loss of sexual function and fertility, patients may feel regret, gender聽incongruence is not a genuine condition, and patients should be directed towards聽psychological therapy instead.

The proposed new Item Numbers would only be applicable to procedures performed on聽adults between the ages of 18 and 50. The application will be heard by several committees聽throughout 2024 before advice is finally presented to the government.