LGBTQIA+ sex reassignment surgery is covered by the universal healthcare scheme (UHC) if there is a medical indication

On December 2nd, Dr. Jodjit Thammatat Ari, the Secretary-General of the National Health Security Office (NHSO), revealed information regarding the case of adding benefits for gender reassignment surgery in the LGBTQIA+ community. It was mentioned that gender reassignment surgery has been included as a basic health insurance benefit since the year 2018, without any exceptions.

In the year 2023, the National Health Security Office announced guidelines on the types and scope of public health services, specifying clearly that any cosmetic procedures without medical indications are not covered and are not reimbursable.

The gender reassignment surgery for the LGBTQIA+ community is covered by the gold card privileges.

Therefore, in cases where there are medical indications, it is clear that the procedure can be performed, and the privileges can be utilized. However, in the past, it was observed that hospitals only processed reimbursements for gender reassignment surgeries in cases of transgender individuals from birth, with approximately 100 cases annually. There have been no reimbursements for gender reassignment surgeries within the LGBTQIA+ community until the year 2023, when Chulalongkorn Hospital processed one case.

The issue with gender reassignment for the LGBTQIA+ group is not related to the entitlement of benefits. However, there has been a lack of discussion on the feasibility and procedures involved. Hospitals have not performed or processed reimbursements for such cases. The National Health Security Office (NHSO) is unaware of the necessary steps, leading to consultations with the public to address concerns related to preventive health promotion, treatment, and recovery processes, spanning from hormone therapy to gender reassignment. Some hormones may not be included in the standard drug list, necessitating a closer examination of the details," stated Dr. Jodjit.

There must be medical guidelines.

However, for guidelines on the necessity of gender reassignment, it is essential to consult with a medical or psychiatric professional to determine whether an individual needs to undergo such a procedure. In the past, it was perceived as a disorder, but today, it is understood from the perspective of those advocating for it that it is not abnormal but a characteristic where one's gender identity does not align with their mind and body.

Therefore, if a physician believes that leaving the matter unaddressed would pose mental health or existential issues, it can be considered. Ultimately, it depends on the medical viewpoint. If deemed necessary by the physician, the procedure can be performed, and we have a system in place to support reimbursements according to the Diagnosis Related Group (DRG) system.

"Surgeries for gender reassignment without medical indications may be perceived as cosmetic, but we are now clarifying that if medically necessary, they fall under health insurance benefits. It is up to the treating physician to decide whether to proceed, aiming to prevent arbitrary decisions. This clarification provides a more defined direction, and we interpret it to enable efficient workflow. We are confident in the new regulations that declare health insurance benefits. In cases where there are medical indications, reimbursements can be processed," stated Dr. Jodjit

 

refer: The Standard