Transgender EuroStudy – Legal Survey and Focus ... - ILGA Europe

Transgender EuroStudy:
Legal Survey and Focus on the
Transgender Experience of Health Care
recognised and addressed so that trans people can access appropriate healthcare and, more broadly,
can move towards social parity.
Acknowledgement of the divisions in responsibility that exist in healthcare policy formation is
helpful in developing the best ways to frame transgender and transsexual health care. In the context
of multiple healthcare systems, it is vital that any move towards equalities priority setting by the
European Union takes into consideration the complexity of funding mechanisms that hold power over
individual care. Setting overall strategies needs to make clear allowances for each type of system,
whether private or public insurance schemes, publicly-funded models or mixtures of each. To make
equality work, equality mainstreaming needs to penetrate each level of healthcare provision, from
national healthcare priority setting to municipal budgeting arrangements, and it must also remain
relevant to each healthcare paradigm.
The ten examples in the following section illustrate the complexities that exist in healthcare
arrangements within the European Union. The aim is to acknowledge the amount of variation in
healthcare provision between Member States and to offer a degree of insight into several challenges
that countries are currently facing, illustrating the differences in healthcare system configurations and
demonstrating the array of historical and social traditions that exist across Europe. In an attempt to
maximise diversity in the following examples, geographic location, type of system and date of
accession into the European Union were considered. Among those chosen, four countries have been
Member States for over a decade (Finland, France, Germany and the UK), four countries joined the EU
in 2004 (Cyprus, Hungary, Lithuania and Poland) and finally, two States joined the EU in 2007 (Bulgaria
and Romania). More extensive research on the healthcare systems of each European country may
prove helpful in considering specific provisions for trans people going forward, but is beyond the size
and scope of this project.
An Overview of the Healthcare
Arrangements in Ten
Countries of the European
Union 45
45
It should be noted
that reforms in the
health care sector are
frequent and the
information contained
within this document is
accurate as of the
individual dates of
attribution.
Bulgaria: In the new EU Member State of Bulgaria, health insurance is mandatory. A basic
health package is provided by a single National Health Insurance Fund with health insurance funds
split up into 28 regions. For services outside of this package there are also 11 voluntary insurance
funds and the option of out-of-pocket services. In Bulgaria, patients have choices in some areas of
their care, such as the selection of general practitioners and inpatient facilities. Services are publicly
funded but often privately provided by practices that have contracts with the Health Insurance Fund.
Due to economic decline in the 1990s, healthcare spending has decreased in relation to Gross
Domestic Product (GDP) and a growing share of the financing is coming from out-of-pocket payments
(Arnaudova, 2006). However, Bulgaria has plans to increase spending on health over the next few years
using funds generated by privatisation and increased insurance contributions, as well as EU structural
funds (Ministry of Health of the Republic of Bulgaria, 2007).