The the Chief Assessor’s office as it

 The larger system links to the access to medical and health services. MSPis the public health insurance available for Canadians and permanent residents to cover medically necessary services. One has to pay monthly rates or premiums. It aids to meet a portion of the costs of the health care system in BC. MSP approval is a requirement before a transman or a transwoman can access GAS in BC. Changes have happened in the last 3 years in relation to the MSP funding process.  Changes as of December 2014 regarding MSP coverage, BC residents are automatically covered by MSP once they are given the recommendations for surgery (Trans Care BC, 2017). The process may seem better and straightforward but this can still create distress to some transgender individuals who do not have the capacity to pay the monthly premiums. Assistance is required for transgender individuals, who are financially unstable by providing legislations that would give more opportunities to find jobs, promote workplace inclusiveness, and address violence, ostracism and discrimination. Rodney et al, (2013) recommended that dialogues must be ensured to meet standards in order to be heard especially the vulnerable subpopulations. Policy creation is done in order to help the community by involving policymakers, companies, transgender groups and Human Rights representatives. Changes might take a while to happen but there is a current change that is happening with the access to GAS in the recent years. Another change that happened as of December 2016, the results of assessments will be received through their PCP because approval letters do not have to undergo a centralized sign-off from the Chief Assessor’s office as it is no longer in existence (Trans Care BC, 2017). BC Human Rights code (2017) plays a big role in implementing policies surrounding discrimination.  Transgender individuals are to be treated equally and be given the same access just like the general public to services. Not to be denied services from a healthcare provider and be given opportunities to participate in health care programs. The Human Rights Code in BC (2017) also has a stipulation about wait times. It is discriminatory to wait longer than cisgender people for procedures that are medically comparable such as hysterectomy and orchiectomy. Wait times are an issue with access to GAS.  According to the survey done by Frohard-Dourlent, Villalobos & Saewyc (2017), wait times in BC are 150 days or less while the rest of Canada is 180 days. This is between referral and the readiness assessment appointment. The procedures with the highest wait times are facial feminization, breast augmentation, tracheal shave and phalloplasty. The wait times can be attributed to the number of physicians available to do the procedure. How these resources are accessed is outlined in the WPATH guideline but how the structure is made to access them creates an unfair and unjust process. Maiese (2003) claimed that distributive justice is a matter of process and outcome. The process of distribution must deal with the allocation of goods distributed fairly to everyone. However, in the case of GAS, it does not reach a lot of transgender individuals. Those living in a rural setting are having difficulty finding a PCP who would be able to cater to their specific needs. SRS in particular wherein there is only one place in Canada that it can be done. Considering the geographic location, income, and social support, most transgender individuals are not able to access it, if not, delays accumulate in acquiring the surgery. Resources that are distributed unfairly can become a significant concern and can cause social unrest. Ontario, for example, has embraced the idea to assist transgender individuals in accessing GAS by allowing more health care providers provide recommendations for SRS (Toivonen and Dobson, 2017). Wait times for someone connotes inconvenience but for some, it can be deleterious, research has shown that it has a strong correlation with suicide risk (Bailey et al., 2014). In Canada, the surgeon is the one who ultimately provides and performs the Sexual Reassignment Surgery (SRS); however, the process before getting approval for SRS requires undergoing GAS, as it is the big umbrella guideline where SRS is only a portion of the process.  Some individuals opt to go to Thailand to have their procedures but this costs money; hence, causing distress as the option is not economically feasible for some and this further results in more psychological and mental suffering. Funding from the provincial and federal government should include the recruitment of physicians to engage in doing transgender medicine. BC wait times for the SRA in between referral and the appointment is below average than the rest of Canada but in order to mitigate the wait times, the provincial government should work on training new surgeons to assists transgender patients to have surgery within the province (Frohard-Dourlent, Strayed & Saewyc, 2017). Additional assessors providing assessments and recommendations can help in reducing the wait times to decrease frustrations and anxiety. Engaging provincial government together with Transcare BC would establish easier navigation of the system and will create a patient centred approach. It is necessary to have,”clear and detailed information on the access to, and the delivery of gender-confirming surgery” and this can be done with collaboration with the health care professionals and policy makers (Frouhard-Dourlent, Villalobos, & Saewyc, 2017 p. 3). Negotiation should be instituted in order to assist every individual accessing the service in order to cater to his or her complex varied needs and interest within the system (Rodney et al., 2013). In the case of SRA, it should be clear to every transgender individuals as it stands it is not really a requirement by MSP but rather by the surgeons. Physicians and assessors should clearly explain to transgender individuals the process to provide a clearer pathway of information. Regulations should be instituted and the province of BC should look into adding more physicians or other health care professionals to provide recommendations for accessing GAS. Hormones and upper body surgery normally require one letter recommendation while lower body surgery requires two letters (Wylie, et al., 2016). A streamlined standard of practice should be initiated in BC. Appropriate training and professional licensure should remain aligned with the WPATH standards (Toivonen & Dobson, 201) and demonstrated competency in gender dysphoria (Wylie, et al., 2016) will help minimize harm, the perpetuation of stigma, decrease discrimination and promote acceptance (Hann et al., 2017). ConclusionAccess to GAS is quite a process and really dwells on the issue of equality and distributive justice. The idea of falling outside the norm as a transgender can create a profound negative mental effect. Assessments required in order to avail GAS can be a daunting experience and the transgender community face difficult physical and emotional challenges. Suitability for receiving GAS is complex. There are drawbacks and benefits and they should be carefully looked at in order to come up with a comprehensive assessment and recommendation in order to proceed with the surgery. Considerations such as care of the individual, social support; physician and health care professional competency and trainings are crucial in attaining a positive outcome, which aligns the WPATH guidelines. Collaboration with health care practitioners and policy makers surrounding multidisciplinary teams, open communication, barriers to access, addressing autonomy and carefully integrating legislations and jurisprudence will inevitably lessen conflict, confusion and promote respect. Lastly, it will hopefully bolster affirming transgender health and competently serve the transgender population.