Public Hospital Funding and Classification
It feels like we've made progress in terms of recognition but I've recently come across a few things that may be the reason why there's no service commissioning of gender affirming surgeries in public hospitals and how it's still misclassified.
[1] Public hospitals fund procedures based on Activity Based Funding which are based on the AR-DRGS that map to the ICD-10-AM/ACHI/ACS codes. In the AR-DRG version 12 manual appendices and the descriptions document I found the ICD-10-AM code F64 Gender Incongruence is mapped to MDC 19 which is Mental Diseases and Disorders and then it also sits under the Adjacent DRG U67 which is Personality Disorders and Acute Reactions. This all sits under the medical treatment partition which excludes surgical interventions.
https://www.ihacpa.gov.au/health-care/classification/admitted-acute-care/ar-drgs
The current ICD-11-HA60 has moved it out of mental health classification and into sexual health. It's not clear when the ihacpa will adopt the new updated classification. The other important aspect is why haven't public hospitals commissioned gender affirming surgeries previously?
[2] I received a response from the National Health and Medical Research Council regarding an FOI and they only found one document that mentions gender incongruence in adults. There seems to be no clinical framework in Australia for gender affirming surgeries. They rely on general guidelines such as informed decision making, the AusPATH guideliens on HRT and the WPATH standards of care.
I think these two aspects are highly relevant to the systemic barriers when receiving clinically indicated treatment in public hospitals, as there's no clearly defined referral pathway, no multidisciplinary assessment, treatment and aftercare. I would love to hear from people.