Doctoral Dissertation Research: The Public Provision of Healthcare Under Changing Conditions in North and South America

有争议的医疗保健或诊断形式不可避免地涉及对适当定义和治疗的审议，而这些辩论在公共资金方面更加两极分化。活动家和卫生保健提供者由两个核心群体组成，涉及如何将某些形式的保健纳入或排除在公共覆盖范围之外。本文采用比较的方法，考察了美国和阿根廷的医疗保健提供者和社会运动活动家是如何对公共提供的有争议的医疗保健形式进行概念化的。关于变性人保健(一个极具争议性和新出现的实践领域)的例子，它询问纽约市和布宜诺斯艾利斯如何开展两种不同的公共复盖变性人保健的办法。这两个城市都是医疗保健提供者和社会运动活动家的所在地，他们把自己描述为变性人健康领域的领导者。该项目将审查这些地方的医疗保健提供者和社会运动活动家如何工作来定义或重新定义诊断，以及他们如何在跨性别医疗保健的公共覆盖系统中导航。数据收集包括对纽约市和布宜诺斯艾利斯的60至90名医疗保健提供者、患者和社会运动参与者的采访，以及对这两个地点与变性人医疗保健相关的相关文件和立法的内容分析。二次分析还将审查世界卫生组织国际疾病分类的当前修订，其中一些较旧的诊断正在重新编写、替换和重新定义。一个由全球专家组成的工作组，包括来自阿根廷和美国的个人，正在建议对与变性人医疗保健相关的诊断进行重大修改，跨国活动家网络也在提供持续的反馈。在分析这些过程时，本文还探讨了具有不同专业知识的多个跨国行为者在诊断修订过程中是如何协调或冲突的。该项目旨在通过揭示卫生保健提供者和活动家如何影响公共政策和诊断分类的定义来改善社会中个人的福祉。

Contested forms of health care or diagnosis inevitably involve deliberations about proper definition and treatment, and these debates are all the more polarized where public funding is concerned. Activists and health care providers comprise two central groups with a stake in how certain forms of care are included or excluded from public coverage. Taking a comparative approach, this dissertation examines how health care providers and social movement activists in the U.S. and Argentina conceptualize the public provision of contested forms of health care. Addressing the example of transgender health care (a highly contested and emergent field of practice) it asks how two different approaches to public coverage for transgender health care have unfolded in New York City and in Buenos Aires. Both cities are host to health care providers and social movement activists who characterize themselves as leaders in transgender health.The project will examine how health care providers and social movement activists in these places work to define or redefine diagnoses and how they navigate systems of public coverage for transgender health care. The data collection involves interviews with 60 to 90 healthcare providers, patients, and social movement actors in New York City and Buenos Aires, combined with a content analysis of relvant documents and legislation associated with transgender healthcare at both sites. A secondary analysis will also examine the current revision of the World Health Organization's International Classification of Diseases, in which a number of older diagnoses are being reworked, replaced, and redefined. A working group of global experts, including individuals from Argentina and the U.S., are proposing major changes to diagnoses associated with transgender health care, and transnational activist networks are also providing ongoing feedback. In analyzing these processes, this dissertation also asks how multiple transnational actors with ranging expertise coordinate or conflict in the process of diagnostic revision. This project stands to improve the well-being of individuals in society by revealing how health care providers and activists shape public policy and definitions of diagnostic classifications.