Table 2. Open in new tab Expected...

Type of gender-affirming surgery, % (95% CI)^a
Overall
Public health insurance^b	31.1 (26.1-36.5)	32.7 (28.0-37.7)	37.0 (27.1-48.0)	<.001
Private health insurance	59.8 (54.5-64.9)	62.2 (57.3-67.0)	48.7 (38.5-59.0)
Self-pay	5.4 (4.2-6.9)	3.1 (2.0-4.6)	10.8 (7.0-16.3)
Other^c	3.7 (2.2-6.3)	2.1 (1.4-3.1)	3.5 (2.1-5.8)
Northeast
Public health insurance^b	43.1 (34.1-52.5)	41.8 (35.1-48.8)	59.0 (40.9-75.0)	<.05
Private health insurance	49.9 (40.6-59.2)	52.7 (45.8-59.6)	21.7 (13.8-32.2)
Self-pay	6.4 (3.7-11.0)	3.9 (1.7-8.8)	16.4 (7.4-32.7)
Other^c	0.6 (0.3-1.2)	1.5 (0.8-2.8)	2.9 (0.8-9.8)
Midwest
Public health insurance^b	17.5 (11.9-25.0)	27.1 (22.8-31.9)	23.4 (15.7-33.3)	<.001
Private health insurance	64.2 (55.7-71.9)	68.3 (63.7-72.6)	54.8 (44.5-64.8)
Self-pay	7.9 (5.5-11.2)	2.4 (1.4-4.0)	8.3 (4.5-14.7)
Other^c	10.4 (3.8-25.3)	2.2 (1.5-3.3)	13.5 (6.0-27.7)
South
Public health insurance^b	26.7 (17.7-38.2)	15.9 (10.2-23.8)	28.0 (15.8-44.6)	<.001
Private health insurance	62.8 (52.5-72.1)	75.7 (70.0-81.0)	43.9 (32.6-56.0)
Self-pay	7.7 (4.5-12.8)	6.5 (3.8-10.9)	23.4 (10.1-45.5)
Other^c	2.8 (1.2-6.2)	1.9 (0.8-4.2)	4.7 (1.5-13.4)
West
Public health insurance^b	26.7 (21.8-39.0)	36.8 (28.7-45.7)	33.6 (20.5-49.8)	0.095
Private health insurance	63.2 (53.9-71.5)	59.5 (49.8-68.6)	57.9 (42.9-71.5)
Self-pay	3.5 (2.1-5.8)	1.3 (0.8-2.1)	6.3 (3.0-12.5)
Other^c	3.7 (1.7-7.6)	2.4 (1.2-4.7)	2.2 (1.0-4.9)

Type of gender-affirming surgery, % (95% CI)^a

Chest reconstruction

Genital or reproductive

Facial

P value

Overall

Public health insurance^b

31.1 (26.1-36.5)

32.7 (28.0-37.7)

37.0 (27.1-48.0)

<.001

Private health insurance

59.8 (54.5-64.9)

62.2 (57.3-67.0)

48.7 (38.5-59.0)

Self-pay

5.4 (4.2-6.9)

3.1 (2.0-4.6)

10.8 (7.0-16.3)

Other^c

3.7 (2.2-6.3)

2.1 (1.4-3.1)

3.5 (2.1-5.8)

Northeast

Public health insurance^b

43.1 (34.1-52.5)

41.8 (35.1-48.8)

59.0 (40.9-75.0)

<.05

Private health insurance

49.9 (40.6-59.2)

52.7 (45.8-59.6)

21.7 (13.8-32.2)

Self-pay

6.4 (3.7-11.0)

3.9 (1.7-8.8)

16.4 (7.4-32.7)

Other^c

0.6 (0.3-1.2)

1.5 (0.8-2.8)

2.9 (0.8-9.8)

Midwest

Public health insurance^b

17.5 (11.9-25.0)

27.1 (22.8-31.9)

23.4 (15.7-33.3)

<.001

Private health insurance

64.2 (55.7-71.9)

68.3 (63.7-72.6)

54.8 (44.5-64.8)

Self-pay

7.9 (5.5-11.2)

2.4 (1.4-4.0)

8.3 (4.5-14.7)

Other^c

10.4 (3.8-25.3)

2.2 (1.5-3.3)

13.5 (6.0-27.7)

South

Public health insurance^b

26.7 (17.7-38.2)

15.9 (10.2-23.8)

28.0 (15.8-44.6)

<.001

Private health insurance

62.8 (52.5-72.1)

75.7 (70.0-81.0)

43.9 (32.6-56.0)

Self-pay

7.7 (4.5-12.8)

6.5 (3.8-10.9)

23.4 (10.1-45.5)

Other^c

2.8 (1.2-6.2)

1.9 (0.8-4.2)

4.7 (1.5-13.4)

West

Public health insurance^b

26.7 (21.8-39.0)

36.8 (28.7-45.7)

33.6 (20.5-49.8)

0.095

Private health insurance

63.2 (53.9-71.5)

59.5 (49.8-68.6)

57.9 (42.9-71.5)

Self-pay

3.5 (2.1-5.8)

1.3 (0.8-2.1)

6.3 (3.0-12.5)

Other^c

3.7 (1.7-7.6)

2.4 (1.2-4.7)

2.2 (1.0-4.9)

Type of gender-affirming surgery, % (95% CI)^a
Overall
Public health insurance^b	31.1 (26.1-36.5)	32.7 (28.0-37.7)	37.0 (27.1-48.0)	<.001
Private health insurance	59.8 (54.5-64.9)	62.2 (57.3-67.0)	48.7 (38.5-59.0)
Self-pay	5.4 (4.2-6.9)	3.1 (2.0-4.6)	10.8 (7.0-16.3)
Other^c	3.7 (2.2-6.3)	2.1 (1.4-3.1)	3.5 (2.1-5.8)
Northeast
Public health insurance^b	43.1 (34.1-52.5)	41.8 (35.1-48.8)	59.0 (40.9-75.0)	<.05
Private health insurance	49.9 (40.6-59.2)	52.7 (45.8-59.6)	21.7 (13.8-32.2)
Self-pay	6.4 (3.7-11.0)	3.9 (1.7-8.8)	16.4 (7.4-32.7)
Other^c	0.6 (0.3-1.2)	1.5 (0.8-2.8)	2.9 (0.8-9.8)
Midwest
Public health insurance^b	17.5 (11.9-25.0)	27.1 (22.8-31.9)	23.4 (15.7-33.3)	<.001
Private health insurance	64.2 (55.7-71.9)	68.3 (63.7-72.6)	54.8 (44.5-64.8)
Self-pay	7.9 (5.5-11.2)	2.4 (1.4-4.0)	8.3 (4.5-14.7)
Other^c	10.4 (3.8-25.3)	2.2 (1.5-3.3)	13.5 (6.0-27.7)
South
Public health insurance^b	26.7 (17.7-38.2)	15.9 (10.2-23.8)	28.0 (15.8-44.6)	<.001
Private health insurance	62.8 (52.5-72.1)	75.7 (70.0-81.0)	43.9 (32.6-56.0)
Self-pay	7.7 (4.5-12.8)	6.5 (3.8-10.9)	23.4 (10.1-45.5)
Other^c	2.8 (1.2-6.2)	1.9 (0.8-4.2)	4.7 (1.5-13.4)
West
Public health insurance^b	26.7 (21.8-39.0)	36.8 (28.7-45.7)	33.6 (20.5-49.8)	0.095
Private health insurance	63.2 (53.9-71.5)	59.5 (49.8-68.6)	57.9 (42.9-71.5)
Self-pay	3.5 (2.1-5.8)	1.3 (0.8-2.1)	6.3 (3.0-12.5)
Other^c	3.7 (1.7-7.6)	2.4 (1.2-4.7)	2.2 (1.0-4.9)

Table 2.

Open in new tab

Expected Primary Payer for Gender-Affirming Surgery by Type and Region, 2016-2019

Type of gender-affirming surgery, % (95% CI)^a
	Chest reconstruction	Genital or reproductive	Facial	P value
Overall
Public health insurance^b	31.1 (26.1-36.5)	32.7 (28.0-37.7)	37.0 (27.1-48.0)	<.001
Private health insurance	59.8 (54.5-64.9)	62.2 (57.3-67.0)	48.7 (38.5-59.0)
Self-pay	5.4 (4.2-6.9)	3.1 (2.0-4.6)	10.8 (7.0-16.3)
Other^c	3.7 (2.2-6.3)	2.1 (1.4-3.1)	3.5 (2.1-5.8)
Northeast
Public health insurance^b	43.1 (34.1-52.5)	41.8 (35.1-48.8)	59.0 (40.9-75.0)	<.05
Private health insurance	49.9 (40.6-59.2)	52.7 (45.8-59.6)	21.7 (13.8-32.2)
Self-pay	6.4 (3.7-11.0)	3.9 (1.7-8.8)	16.4 (7.4-32.7)
Other^c	0.6 (0.3-1.2)	1.5 (0.8-2.8)	2.9 (0.8-9.8)
Midwest
Public health insurance^b	17.5 (11.9-25.0)	27.1 (22.8-31.9)	23.4 (15.7-33.3)	<.001
Private health insurance	64.2 (55.7-71.9)	68.3 (63.7-72.6)	54.8 (44.5-64.8)
Self-pay	7.9 (5.5-11.2)	2.4 (1.4-4.0)	8.3 (4.5-14.7)
Other^c	10.4 (3.8-25.3)	2.2 (1.5-3.3)	13.5 (6.0-27.7)
South
Public health insurance^b	26.7 (17.7-38.2)	15.9 (10.2-23.8)	28.0 (15.8-44.6)	<.001
Private health insurance	62.8 (52.5-72.1)	75.7 (70.0-81.0)	43.9 (32.6-56.0)
Self-pay	7.7 (4.5-12.8)	6.5 (3.8-10.9)	23.4 (10.1-45.5)
Other^c	2.8 (1.2-6.2)	1.9 (0.8-4.2)	4.7 (1.5-13.4)
West
Public health insurance^b	26.7 (21.8-39.0)	36.8 (28.7-45.7)	33.6 (20.5-49.8)	0.095
Private health insurance	63.2 (53.9-71.5)	59.5 (49.8-68.6)	57.9 (42.9-71.5)
Self-pay	3.5 (2.1-5.8)	1.3 (0.8-2.1)	6.3 (3.0-12.5)
Other^c	3.7 (1.7-7.6)	2.4 (1.2-4.7)	2.2 (1.0-4.9)

Type of gender-affirming surgery, % (95% CI)^a
	Chest reconstruction	Genital or reproductive	Facial	P value
Overall
Public health insurance^b	31.1 (26.1-36.5)	32.7 (28.0-37.7)	37.0 (27.1-48.0)	<.001
Private health insurance	59.8 (54.5-64.9)	62.2 (57.3-67.0)	48.7 (38.5-59.0)
Self-pay	5.4 (4.2-6.9)	3.1 (2.0-4.6)	10.8 (7.0-16.3)
Other^c	3.7 (2.2-6.3)	2.1 (1.4-3.1)	3.5 (2.1-5.8)
Northeast
Public health insurance^b	43.1 (34.1-52.5)	41.8 (35.1-48.8)	59.0 (40.9-75.0)	<.05
Private health insurance	49.9 (40.6-59.2)	52.7 (45.8-59.6)	21.7 (13.8-32.2)
Self-pay	6.4 (3.7-11.0)	3.9 (1.7-8.8)	16.4 (7.4-32.7)
Other^c	0.6 (0.3-1.2)	1.5 (0.8-2.8)	2.9 (0.8-9.8)
Midwest
Public health insurance^b	17.5 (11.9-25.0)	27.1 (22.8-31.9)	23.4 (15.7-33.3)	<.001
Private health insurance	64.2 (55.7-71.9)	68.3 (63.7-72.6)	54.8 (44.5-64.8)
Self-pay	7.9 (5.5-11.2)	2.4 (1.4-4.0)	8.3 (4.5-14.7)
Other^c	10.4 (3.8-25.3)	2.2 (1.5-3.3)	13.5 (6.0-27.7)
South
Public health insurance^b	26.7 (17.7-38.2)	15.9 (10.2-23.8)	28.0 (15.8-44.6)	<.001
Private health insurance	62.8 (52.5-72.1)	75.7 (70.0-81.0)	43.9 (32.6-56.0)
Self-pay	7.7 (4.5-12.8)	6.5 (3.8-10.9)	23.4 (10.1-45.5)
Other^c	2.8 (1.2-6.2)	1.9 (0.8-4.2)	4.7 (1.5-13.4)
West
Public health insurance^b	26.7 (21.8-39.0)	36.8 (28.7-45.7)	33.6 (20.5-49.8)	0.095
Private health insurance	63.2 (53.9-71.5)	59.5 (49.8-68.6)	57.9 (42.9-71.5)
Self-pay	3.5 (2.1-5.8)	1.3 (0.8-2.1)	6.3 (3.0-12.5)
Other^c	3.7 (1.7-7.6)	2.4 (1.2-4.7)	2.2 (1.0-4.9)

Data are from the 2016-2019 Nationwide Ambulatory Surgery Sample. ^aPercentages are calculated with survey weights. ^bPublic health insurance included Medicare and Medicaid. ^cIncluded no charge or other expected primary payers. CI, confidence interval.

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