Barriers To Healthcare: LGBTQ+
Eliminating disparities and enhancing efforts to improve LGBTQ+ health is essential to ensure that the people in this community can lead healthy lives. Healthypeople.gov states that some of the benefits of addressing these disparities and health concerns include reduction in disease transmission and progression, increased mental and physical well being, reduced healthcare costs, and increased longevity. However, there are certain barriers people in the LGBTQ+ community face when trying to obtain healthcare treatment.
The first is limited access. Many LGBTQ+ patients who cannot afford healthcare are often denied it as a result. In 10 US states, transition-related health care is expressly excluded from Medicaid coverage, limiting options for low-income transgender people. LGBTQ+ patients also have a harder time obtaining healthcare insurance in the US. As of July 2018, 37 states do not expressly ban health insurance discrimination based on sexual orientation or gender identity. Some states, such as New Jersey, prohibit discrimination based on gender identity but not sexual orientation, decreasing the likelihood of LGBTQ+ patients obtaining healthcare services (Source).
Next is the refusal of care. LGBT patients are often refused services outright because of their sexual orientation or gender identity. In a nationally representative survey conducted by the Center for American Progress in 2017, 8 percent of lesbian, gay, and bisexual respondents and 29 percent of transgender respondents reported that a healthcare provider had refused to see them because of their sexual orientation or gender identity in the past year. Interviewees described being denied counseling and therapy, refused fertility treatments, denied a checkup or other primary care services, and in one instance, told that a pediatrician’s religious beliefs precluded her from evaluating a same-sex couple’s 6-day-old child (Source).
Another barrier to healthcare for LGBTQ+ patients is negative experiences with the healthcare system. For example, Trevor L., a gay man in Memphis, recalled an incident when he took an HIV test at his annual checkup in 2016: “and they sat down and started preaching to me – not biblical things, but saying, you know this is not appropriate, I can help you with counseling, and I was like, oh, thank you, I’ve been out for 20 years and I think I’m okay. It’s almost like they feel they have the right to tell you that it’s wrong.” Both providers and LGBT people noted that concerns about discrimination and mistreatment led LGBT people to delay or forego care. A 2015 survey of almost 28,000 transgender people found that, in the year preceding the survey, 23 percent did not seek the care they needed because of concern about mistreatment based on gender identity (Source).
Lastly, some doctors do not have experience in treating transgender individuals, which may lead to inadequate health services. Despite both guidelines and data supporting the current transgender medicine treatment paradigm, transgender patients report that the lack of providers with expertise in transgender medicine represents the single largest component inhibiting access. Transgender treatment is not taught in conventional medical curricula and too few physicians have the requisite knowledge and comfort level.
By: Sreenidhi Saripalli
