Lesbians, gay men and bisexual adults in California are more likely than straight people to delay seeking medical care, even though they have the same or even higher rates of health insurance coverage, according to a new study.
Researchers at UCLA examined survey data from about 83,000 California adults that included questions on a variety of health indicators, including access to health care and insurance, health problems, health behaviors and sexual orientation. They found that gay and bisexual men were more likely than straight men to have health insurance, while lesbian and bisexual women had similar rates of health insurance coverage compared to straight women.
But when it came to actually using their health insurance coverage, gay, lesbian and bisexual adults lagged significantly behind their straight peers. Twenty percent of gay men and 21 percent of bisexual men reported delaying seeking health care in the past year, compared to 13 percent of straight men.
Among gay and bisexual women the difference was even more pronounced. While just 18 percent of straight women reported delaying care, almost 30 percent of lesbians and bisexual women said they’d put off seeing a doctor.
“Unfortunately we don’t have the data to answer (why) directly,” said Susan Babey, one of the authors of the report. “But other research suggests that one possibility is that lesbian, gay and bisexual adults have experienced discrimination or not feeling welcome in health care settings in the past and so are avoiding repeating those kinds of experiences by delaying care even if they need to see a medical provider.”
That conclusion sounded right to Amanda Wallner, director of the California LGBT Health and Human Services Network, a statewide coalition of non-profit providers, community centers, and researchers advocating for policies and resources to advance LGBT health.
“It’s something that we’ve actually known about for a while. Other studies have shown similar findings and anecdotally we hear stories about this all the time,” she said. “It’s an entirely rational reaction…[LGBT adults] are responding to either their own previous experiences of discrimination or to a perception that they may experience that.”
Wallner said she’s heard stories of doctors refusing to provide certain medical treatment to LGBT people, questioning their lifestyle behaviors and not respecting their relationships. Another problem is transportation, she said. Some people only want to go to clinics they know are friendly to the LGBT community. But getting to those clinics can be a challenge, she said, because there often aren’t many of them and they may be far from where patients live.
When people don’t seek medical care early it can be costly to both patients and society, said Babey. Those who delay seeing a doctor can end up with more serious and difficult-to-treat health conditions, and are more likely to need emergency care, she said. In fact, the UCLA study shows gay, lesbian and bisexual adults visited the emergency department more often than straight adults. The difference was especially pronounced for bisexuals.
The study didn’t examine health access for transgender and questioning people. That was due to a lack of survey data on that population, Babey said. However, the researchers plan to look into the issue in a future study, she said.
Wallner said health providers can help address LGBT patients’ distrust of the medical system by taking steps to be more affirming toward them. Practices should include using patients’ preferred names and pronouns, asking LGBT people about their relationships but not focusing on sexual orientation to the exclusion of other aspects of their lives, conducting training on LGBTQ awareness and cultural competency, partnering with local LGBTQ organizations to do outreach, and showing posters in their health care practices that include LGBT people and families, she said.
“I look forward to the day when we start to chip away at those disparities and people do feel comfortable going into their doctor,” Wallner said. “We need to break down the stigma because it’s killing people.”