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

Transgender EuroStudy:
Legal Survey and Focus on the
Transgender Experience of Health Care
Discussion
The variation in healthcare systems as outlined above, results in dissimilar positions for trans
patients within the national health schemes of the European Union. Systemic variations, along with
differences in treatment philosophies, can influence the options that are or are not available under
public healthcare systems. Due to the several different types of funding arrangements at a national
level as well as differences in local priorities, drawing together European-wide policy on transgender
and transsexual health presents us with some great challenges. As very little has been published on
this topic it is difficult to get a sense of the overall picture of healthcare for trans people in Europe.
However, this lack of publication and research does not reflect the active social advocacy networks for
trans people at the local, national and European levels. The low priority placed on trans-related
research and policy development is further evidence of social and political exclusion experienced by
trans people. Though it may seem difficult to organise the type of coordination that is required to fight
discrimination in healthcare provision and other areas of policy development, it is imperative that
inequalities are addressed and actively tackled.
Inclusion or Refusal
At present, some European countries provide comprehensive services for trans people who
transition, including psychological, hormonal and surgical treatments as part of their public healthcare
schemes, whilst other countries specifically discriminate against trans people by categorically refusing
to provide transition-related medical services. In the United Kingdom, most health authorities within
the National Health Service do provide services to transsexuals, though waiting lists can be long and
care is rarely provided locally (Murjan et al). ‘Healthcare Wales’ which provides NHS care and funding
for residents of Wales currently refuses to fund any assessment or treatment services to trans people.
Some countries have explicit exemption policies to funding services related to gender
reassignment. In Poland, for example, a decree by the Minister of Health in 2003 defined sex
reassignment surgery as a “non-standard health service” that is specifically excluded from being
covered under the National Health Fund. This list also included “plastic surgery and cosmetic
procedures if these are not connected with disease or its consequences, congenital malformation or
injury” and “acupuncture, except for pain relief” (Kuszewski and Gericke, 2005). Other countries provide
a mixture of public and private treatment options, but the availability of services often varies by
locality.
One startling reality for those seeking transition-related services is that information is often very
difficult to find. Policy in this area of medicine, including information about entitlement to treatment
under national healthcare schemes, is not always made explicit. This can leave patients vulnerable to
discrimination and prejudice if they come across a practitioner who is unwilling or unable to treat
them. Some patients find themselves in the precarious situation of having to advocate for themselves
with few resources and very little, if any, systemic support. For the practitioner, the relatively small
population of trans people means they may not have developed the knowledge required to meet the
healthcare needs of the patient, whether related to general healthcare or specifically to transition-