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One of the country’s biggest medical insurers will no longer cover private practitioners prescribing gender-affirming care to adolescents, in a move that could leave young people languishing on already-stretched public waiting lists.
MDA National, one of four major medical indemnity providers insuring GPs and other private practitioners against legal claims, updated its policy this month to exclude cover for claims “arising from aspects of gender transitioning treatment for under 18-year-old patients”.
Dr Michelle Dutton is moving medical insurers following a decision to cut cover for GPs providing gender-affirming care.Credit: Joe Armao
Dr Michael Gannon, the organisation’s president, said young people experiencing gender dysphoria should be initially assessed by multidisciplinary teams in hospital – not by GPs.
“This is the same hospital system that is very, very comfortable placing greater demands on general practitioners,” he said. “It’s simply not fair to ask individual GPs in the suburbs or the bush to be making these complex decisions on their own.”
Gannon said the decision was made in response to legal cases overseas, including the high-profile inquiry into, and subsequent closure of, Britain’s only children’s gender clinic.
“We’re not taking a moral stance or an ethical stance – this is very much an insurance decision,” he said. “We don’t think we can accurately and fairly price the risk of regret.”
Dr Michelle Dutton, a GP in Fitzroy North in Melbourne, said she was leaving MDA National for a different provider before the change takes effect on July 1.
“It’s disappointing … I need to be covered for the work that I do as a GP, and if that work is no longer covered, I need to find a different provider,” she said. “I would have changed anyway because I fundamentally disagree with the decision.”
Dr Portia Predny in her office at Rozelle Medical Centre.Credit: Dominic Lorrimer
Dr Portia Predny, a GP at Sydney’s Rozelle Medical Centre and vice-president of the trans health advocacy body AusPATH, said she was concerned the change would further limit the options available to transgender adolescents by discouraging private practitioners from treating them.
“There are very few clinics who actually service this group of patients,” she said. “There’s already barriers to care for this age group – this is care that’s often life-saving, and that’s not an exaggeration.”
She said AusPATH had been reassured by two other major insurers, Avant and Medical Indemnity Protection Society (MIPs), that they would continue to cover GPs prescribing hormones to transgender patients under 18.
Predny said GPs were already working with other healthcare providers, such as psychiatrists and endocrinologists, to provide safe care to young patients.
“To state that the only way for people to access interdisciplinary care is through a multidisciplinary clinic [at a hospital] is misleading,” she said.
NSW has publicly funded gender clinics at Westmead Hospital and Maple Leaf House in Newcastle.
As of March 2023, there were 139 clients aged under 25 waiting for treatment at Maple Leaf House, though a spokesperson said not all those patients would be seeking medical-affirming care.
In Victoria, the Monash Health Gender Clinic is the only specialist public service available to transgender people between the ages of 16 and 18.
Associate Professor Ruth McNair, from the University of Melbourne’s department of general practice, said requiring every young person experiencing gender dysphoria to go through a public gender clinic first would place an even greater strain on waiting lists.
“The system is overloaded,” she said. “Kids are left with nowhere to go.”
McNair said GPs who prescribe hormones to underage patients were already very cautious, and any patients with complex clinical histories, such as pre-existing mental health problems or past trauma, were urgently referred to public clinics for specialist treatment.
“I consider the risk to be higher if I’m blocking a young person from care,” she said. “What’s the real risk? It’s to the health of the young person.
“It’s a bit short-sighted really. They’re trying to capture the [minority] of cases [where patients regret].”
MDA National will still cover GPs providing repeat prescriptions for gender-affirming hormones and general healthcare for patients with gender dysphoria.
The company said the decision would affect “well under a hundred” of its 40,000 members.
In 2021, the Royal Australian and New Zealand College of Psychiatrists released a position statement defining a “gender-affirmative approach” as one that accepts rather than questions a child’s statements about their gender identity.
In a rare local case, a Sydney woman is suing her psychiatrist for professional negligence relating to her gender transition, which she began at age 19.
However, the regret rate for people who medically transition in childhood or adolescence remains low.
Last year, a Dutch study published in The Lancet found 98 per cent of 720 transgender participants who started gender-affirming hormones in adolescence continued their treatment into adulthood.
A 2021 systematic review of 27 studies with a combined 7928 transgender patients found about 1 per cent expressed regret after undergoing gender-affirming surgeries.
Eloise Brook, the policy and communication manager at the Gender Centre in Annandale, said the decision jeopardised the “hard work” and investment that has been put into making gender-affirming care more accessible through family GPs.
“This is a moment where I’m fearful for families,” she said. “Insurance should not be the space in which medical decisions should be made.”
Dr Mitch Squire, a GP who provides gender-affirming care to adolescents at his clinic in Sydney’s inner west, said he would have no choice but to move providers if his insurer no longer covered him for the service.
“It would be a pretty straightforward decision for me,” he said. “There is a small but quantifiable regret rate, and given that changes can be permanent, that cover is absolutely essential.”
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