Addressing health care disparities among people in the LGBTQ+ community: June is Pride Month

This is the third article in a series on health care disparities in Michigan. We’re looking at the various aspects of disparities and what Blue Cross Blue Shield of Michigan and its participating health care providers are doing to combat them.

Note: Some of the information in this article was updated May 18, 2021.

Background
Across the nation, June recognizes LGBTQ+ (lesbian, gay, bisexual, transgender and queer or questioning) Pride Month. The celebration commemorates the Stonewall Uprising*, in which police clashed with protesters over a six-day period in Manhattan in June 1969. It’s considered the tipping point for what was then called the Gay Liberation Movement.

The month of June provides an opportunity to recognize and increase awareness of issues among the LGBTQ+ community, featuring educational workshops, parades, lectures, concerts, memorials and celebrations of life remembering those who lost their lives to HIV/AIDS. It’s also an opportunity to look more closely into care delivery — and the health care disparities that exist — for the estimated 4% of Michigan adults identified as LGBTQ+.

LGBTQ+ health and disparities
Mental health conditions, higher rates of alcohol, tobacco and other substance use, as well as higher odds of obesity and eating disorders, are common conditions within the community. In 2016, the LGBTQ+ community was identified as a "health disparity population" by the National Institute on Minority Health and Health Disparities.* This is the result of such issues as access to health care and low utilization of health services due to the population not feeling comfortable or safe sharing gender or sexual identity with health care providers. 

Barriers to care
Members of the LGBTQ+ community face several barriers to care, including exclusion from a partner's health insurance, provider-related discrimination, psychosocial barriers (e.g., fear of disclosing sexual orientation and gender identity or illegal behaviors) and poor matches between the needs of LGBTQ+ people and the kinds of services that are available. 

A 2017 Center for American Progress survey showed that once people experience discrimination in some form, they’re more likely to avoid doctor's offices. Among LGBTQ+ people who had experienced discrimination in the year before the survey, more than 18% reported avoiding doctor's offices out of fear of discrimination.  

Such statistics highlight the importance of ensuring that LGBTQ+ patients have the same opportunities to obtain the best possible clinical outcomes.

What health care providers can do to support LGBTQ+ patients
Structural inequities and bias drive disparities. To address these issues, providers and their office staffs are encouraged to take LGBTQ+ training.

It’s important for health care providers to learn about such things as:

• Specific health care needs of the LGBTQ+ population
• Terminology that LGBTQ+ patients prefer that you use
• Community resources that can help patients with their concerns

Following are links to two training modules you may want to consider:

• Creating an LGBT-Friendly Practice*
• Quality Health Care for Lesbian, Gay, Bisexual and Transgender People* 

Note: These are not Blue Cross-sponsored training sessions.

Blue Cross’ Value Partnerships program recently added a “capability” to the Patient-Centered Medical Home program that includes training on LGBTQ+ health care issues and how to create more inclusive processes. This capability, available for PGIP-participating providers through their physician organization, gives physicians resources to help them provide more compassionate, effective care for members of the LBGTQ+ community.

Blue Cross and its physician organizations are committed to promoting more inclusive  practice units, where staff receives training on the specific needs of LGBTQ+ patients. Here are some examples of how you can build a more inclusive practice: 

• Review policies, procedures, documents and forms to ensure they are inclusive. 
• Allow patients the opportunity to indicate the pronouns and names they wish to use.
• When you call patients from the waiting room, address them in a way that’s not specific to a particular gender.
• Understand the distinction between biological sex and gender identity. 
• Share community resources that can help patients with their concerns.
• Ensure that forms and policies don’t assume a patient's gender or their marital or partner status.
• Make sure the equal opportunity statement on forms addresses gender identity and sexual orientation.

For more information
If you’d like to learn more, check out the following resources, which were used as source material for this article:

• Communities in Action: Pathways to Health Equity*
• The Impact of Stigma and Discrimination Against LGBT People in Michigan
• LGBT Identification Rises to 5.6%*
• Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations*

*Blue Cross Blue Shield of Michigan doesn’t own or control this website.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.