MDOS must treat gender-affirming care equally: AMA

The AMA has urged protection for health practitioners providing gender-affirming care and fairness in MDO coverage.

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Medical defence organisations should not be allowed to refuse to insure gender-affirming care, and medical school curricula should include knowledge of LGBTQIASB+ health, the AMA says.

In its updated LGBTQIASB+ Health Position Statement, released yesterday, the association highlights the government’s role in ensuring indemnity providers upheld coverage for practitioners offering gender-affirming care.

Medical defence organisation MDA National moved to restrict cover for practitioners providing gender-affirming care for adolescents in May 2023, claiming it could not “accurately and fairly price the risk of regret” given the insurance risk carried by policies covering gender-affirming care for patients under 18 years of age.

“The provision of gender-affirming care is beneficial to trans and gender diverse people in all medical contexts, including if they are seeking care for reasons unrelated to their gender,” the AMA statement says.

“[The AMA] calls on the Australian government to ensure that medical practitioners who provide gender-affirming care to patients are protected and supported in the provision of gender-affirming care.

“[It should also] ensure that gender-affirming care is treated no differently to other areas of care covered by medical defence organisations.”

The AMA also called on the government to increase access to Commonwealth-funded gender-affirming procedures, including through “appropriate avenues” under the PBS and MBS, and include sensitive, evidence-based, and community-guided questions on gender, sexual orientation, and intersex variations in the Australian Census.

“There is currently no nationally representative measure of the size of LGBTQIASB+ populations in Australia, largely because robust data on sexual orientation, gender identity and intersex status are not collected in the Census or other representative research studies from which this measure could be extrapolated with confidence,” the statement says.

“The lack of nationally representative data on LGBTQIASB+ populations makes it difficult for governments to plan and design appropriate health services for these communities.

“The Australian Bureau of Statistics has now released a Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variable, which outlines standard questions and answers for these four variables and is designed for use by government, academic and private sector organisations in various research and epidemiological initiatives.

“Full implementation of this standard across federal and state data collection activities, as well as investment in rigorous academic and clinical research, should enhance understanding of the LGBTQIASB+ population in Australia.”

The AMA calls on the Australian Medical Council to establish LGBTQIASB+ health knowledge as a standard graduate outcome for students undertaking medical programs of study in Australia. 

Other AMA priorities for the federal government include:

• Funding high-quality research on LGBTQIASB+ health outcomes and experiences in the healthcare system, including research investigating the impacts of differing service approaches, models of care, and treatment pathways for LGBTQIASB+ patients;
• Support LGBTQIASB+ community-led health services to provide targeted, informed and appropriate support for LGBTQIASB+ people;
• Add sensitive, evidence-based, and community-guided questions on gender, sexual orientation, and intersex variations to the Australian Census;
• Take specific steps to improve access to LGBTQIASB+ inclusive care for regional, rural and remote communities;
• Fund targeted sexual health education aimed at LGBTQIASB+ people; and
• Revise school-based sexual health education curricula to be more inclusive of LGBTQIASB+ sexual and reproductive health needs. 

The statement also outlines the need for state governments to ban coercive “conversion” practices and uphold LGBTQIASB+-inclusive practices within their health systems, including ensuring electronic medical records and other IT systems are designed to acknowledge patient-directed names and pronouns.