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正确定义和治疗的审议，而这些辩论在涉及公共资金时更加两极分化。积极分子和卫生保健提供者组成了两个核心群体，他们对如何将某些形式的保健纳入或排除在公共保险之外有着利害关系。采取比较的方法，本论文探讨了美国和阿根廷的医疗保健提供者和社会运动活动家如何概念化公共提供有争议的医疗保健形式。以跨性别医疗保健为例（这是一个极具争议和新兴的实践领域），报告询问了纽约市和布宜诺斯艾利斯两种不同的跨性别医疗保健公共覆盖方法是如何展开的。这两座城市都有医疗服务提供者和社会运动活动家，他们将自己描述为跨性别健康的领导者。该项目将研究这些地方的医疗保健提供者和社会运动活动家如何界定或重新定义诊断，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访谈，并结合对这两个地点与跨性别医疗保健相关的相关文件和立法的内容分析。第二项分析还将检查世界卫生组织《国际疾病分类》的当前修订版，其中一些旧的诊断正在被重新设计、取代和重新定义。一个由全球专家组成的工作小组，包括来自阿根廷和美国的个人，正在提议对与跨性别医疗保健相关的诊断进行重大改革，跨国活动家网络也在不断提供反馈。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动者在诊断修订过程中如何协调或冲突。该项目旨在通过揭示卫生保健提供者和活动家如何塑造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.