Press Release | 1. June 2006
Study Shows Lesbians Face Significant Barriers to Health Care Access
Who benefits from the health care system in the United States? Studies have long pointed to disparities in access to care along racial and class lines. But, according to a new study by Columbia researchers, sexual orientation may play an equally critical role.
Julia Heck (Epidemiology), Randall Sell (Sociomedical Sciences), Sherri Gorin (Epidemiology/Sociomedical Sciences), all from ColumbiaÂ's Mailman School of Public Health, conducted the first nationwide epidemiological study involving a probability sample to measure health care access in the gay-lesbian-bisexual (GLB) population. The findings, published in the American Journal of Public Health, indicate that lesbians encounter more barriers to health care access than their heterosexual counterparts.
The authors used four criteria to determine health care access: whether a person had insurance coverage, had a regular source of care, had seen a provider in the last year, and had unmet medical needs because of cost issues. They found that women in single-sex relationships were at a significant disadvantage to women in heterosexual relationships in all four categories.
Â"Women in same-sex relationships have lower rates of coverage than those in opposite-sex relationships,Â" explains Heck. Â"This may be at least partially attributed to the inability of same-sex couples to marry or form legal partnerships in most states. More than 40% of insured women in the U.S. are covered through another person. Women are also less likely to be employed in professions that provide an insurance package.Â" In May, Heck received her PhD in Epidemiology from Columbia, where she was also a Graduate Fellow of the Institute for Social and Economic Research and Policy (ISERP).
When they considered gay and heterosexual men, the research team found strikingly different results. Gay men in relationships were shown to have less insurance coverage than men in heterosexual relationships. Both groups were similar in their odds of having unmet medical needs due to cost. However, men with male partners were 40% more likely to have a usual source of care and two-thirds more likely to have seen a health care provider in the previous year.
What might account for this discrepancy? The authors hypothesized that for gay men, the HIV epidemic revolutionized health care, making it more likely for them to have a regular provider and making it easier for them to be open about their sexual orientation. Health risks of particular relevance to the lesbian community, on the other hand, have not received the same level of exposure. As a result, lesbians may feel more disinclined to disclose their sexual orientation to doctors and may feel stigmatized or discriminated against when they do solicit health care services.
What can we do about it? Based on their findings, Heck, Sell, and Gorin highlight the need to design programs that sensitize health care providers to the needs of the lesbian community and raise awareness of the barriers that these women face. They also encourage government and industry to offer health coverage for individuals in domestic partnerships. Marriage status is an important determinant of health insurance coverage in the United States, one that hinders many lesbians from being able to obtain the care they need.
Nevertheless, Heck, Sell, and Gorin are insistent that these measures individually are not enough to solve the problem. Â"Even where domestic partners can receive health coverage for their partners, many donÂ't take it because they donÂ't want to Â'come outÂ' at work,Â" they note. For true improvements in eliminating health disparities based on sexual orientation, the solution must be holistic and must change attitudes—attitudes of the lesbian community to the health care system, attitudes and competencies of providers, and attitudes and policies of the government and employers.
Read the complete article.
Contact: Grace Hong 212-854-9489 gh286@columbia.edu
Julia Heck jeh61@columbia.edu
