• Kyodo


The health ministry’s proposed rule change to allow public health insurance coverage of sex reassignment surgery for people with gender identity disorder (GID) offers those who face steep surgery costs a reason to cheer.

But there are concerns that more people with GID will undergo such surgeries without a full understanding of the associated risks.

The Ministry of Health, Labor and Welfare on Wednesday proposed to an advisory panel allowing the cost of sex reassignment surgery for GID patients to be covered under public health insurance from April. The panel essentially approved the proposal.

Fumino Sugiyama, a female-to-male transgender individual and a leading campaigner for the rights of transgender people, welcomed the latest development as “great” news for people who could not undergo surgery due to financial reasons. According to the 36-year-old Sugiyama, the number of individuals who struggle to make ends meet just to pay for their surgery expenses is not insignificant.

Surgery is currently costly, prompting some to go abroad where the price of undergoing surgery is less expensive. Once the surgery is covered by public insurance in Japan, a patient will only need to pay up to 30 percent of the total surgery expenses.

Citing cases where people encounter problems after returning to Japan from cheap surgery overseas, Sugiyama underlined the merits of this envisaged rule change.

“It is a big (impact) to be able to have continued treatment in the country,” Sugiyama said.

In Japan, GID patients need to undergo sex reassignment surgery to alter their registered gender on official public records. Public health insurance coverage for medical services is currently limited to psychotherapy.

But Aki Nishino, a representative of an association working for people with GID, expressed concern that the planned change may make it easier for people to undergo surgery even before they are able to come to terms with the possible repercussions.

Nishino, 31, said there are people who decide on surgery even without sufficient understanding of the potential aftereffects, thinking that all their worries will be solved with sex reassignment surgery. Some have later regretted their decisions.

To avoid this, Nishino said, “There is a need to ensure that the insurance coverage will lead to better treatment and support frameworks.”

Under the special law enacted in 2004, people with GID are allowed to change the way their gender is listed in their family registries if they fulfill several conditions, including undergoing sex reassignment operations. By the end of 2016, about 6,900 people had changed their gender.

Among GID sufferers, however, there are also those who choose not to have sex reassignment surgery so they can still bear a child.

Minata Hara, representative of a nonprofit group supporting sexual minorities, called for a revision of the law that works on the premise of people with GID undergoing sex reassignment surgery. “If the insurance is used to back this problematic law, there will likely be an adverse effect,” Hara, 61, said.

According to a survey by the Japanese Society of Psychiatry and Neurology, the number of GID patients who have had treatment at medical institutions in the country totaled 22,435 by the end of 2015.

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