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A first-of-its-kind study reported that more transgender people are receiving gender-affirming surgeries.

Medical journal JAMA Surgery reported that from 2000 to 2014, the increase in insurance for transgender people has helped the change, according to the Washington Post. The number of people paying out of pocket for the surgeries went down from 65 percent in 2006-2011 to 39 percent in 2012-2014.

“These changes are driven by a growing expert consensus on the medical necessity of gender transition, new legal interpretations prohibiting insurance discrimination against transgender people, and mounting evidence that transgender-inclusive coverage is cost-effective,” Johns Hopkins Bloomberg School of Public Health’s Kellan Baker wrote in the New England Journal of Medicine last year.

Changes during that time included Medicare and Medicaid altering their policy to accept insurance payments for those surgeries. In total, the research studied 4,118 separate gender reassignment surgeries.