Doing Justice: Ethical Considerations Identifying and Researching Transgender and Gender Diverse People in Insurance Claims Data

被引：1

作者：

Alpert, Ash B. ^{[1
,2
,3
,4
]}

Babbs, Gray ^{[5
]}

Sanaeikia, Rebecca ^{[6
]}

Ellison, Jacqueline ^{[6
,7
]}

Hughes, Landon ^{[8
,9
]}

Herington, Jonathan ^{[10
]}

Dembroff, Robin ^{[11
]}

机构：

[1] Yale Canc Ctr, 333 Cedar St,WWW 205, New Haven, CT 06511 USA

[2] Yale Sch Med, New Haven, CT 06510 USA

[3] Univ Rochester, Med Ctr, Med Ctr, Rochester, NY 14642 USA

[4] Brown Univ, Dept Hlth Serv Policy & Practice, Sch Publ Hlth, Providence, RI 02903 USA

[5] Univ Rochester, Dept Philosophy, Rochester, NY USA

[6] Univ Pittsburgh, Sch Publ Hlth, Dept Hlth Policy & Management, Pittsburgh, PA USA

[7] Univ Pittsburgh, Ctr Innovat Res Gender Hlth Equ, Sch Med, Dept Gen Internal Med, Pittsburgh, PA USA

[8] Harvard Pilgrim Hlth Care Inst, Dept Populat Med, Boston, MA USA

[9] Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA

[10] Univ Rochester, Med Ctr, Dept Hlth Humanities & Bioeth, Rochester, NY USA

[11] Yale Univ, Dept Philosophy, New Haven, CT USA

来源：

JOURNAL OF MEDICAL SYSTEMS | 2024年 / 48卷 / 01期

基金：

美国国家卫生研究院; 美国医疗保健研究与质量局;

关键词：

Transgender Persons; Epistemic Injustice; Ethics; Insurance Claim Review; Administrative Data; HEALTH-CARE;

D O I：

10.1007/s10916-024-02111-w

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Data on the health of transgender and gender diverse (TGD) people are scarce. Researchers are increasingly turning to insurance claims data to investigate disease burden among TGD people. Since claims do not include gender self-identification or modality (i.e., TGD or not), researchers have developed algorithms to attempt to identify TGD individuals using diagnosis, procedure, and prescription codes, sometimes also inferring sex assigned at birth and gender. Claims-based algorithms introduce epistemological and ethical complexities that have yet to be addressed in data informatics, epidemiology, or health services research. We discuss the implications of claims-based algorithms to identify and categorize TGD populations, including perpetuating cisnormative biases and dismissing TGD individuals' self-identification. Using the framework of epistemic injustice, we outline ethical considerations when undertaking claims-based TGD health research and provide suggestions to minimize harms and maximize benefits to TGD individuals and communities.

引用

页数：7