Disparities in Health Insurance Coverage, Access, and Outcomes for Individuals in Same-Sex Versus Different-Sex Relationships, 2000–2007

Buchmueller, Thomas C.; Carpenter, Christopher S.

doi:10.2105/ajph.2009.160804

Cited by 309 publications

(211 citation statements)

References 12 publications

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“…This inequality is evident in terms of access to the healthcare system and use of preventive health services [3,4]. As such, patients who identify as lesbian, gay, bisexual or transgender (LGBT) are at an increased risk for cancer, mental health disorders, substance abuse, and sexually transmitted infections [2,5,6].…”

Section: Introductionmentioning

confidence: 99%

Medical students’ perception of lesbian, gay, bisexual, and transgender (LGBT) discrimination in their learning environment and their self-reported comfort level for caring for LGBT patients: a survey study

Nama

MacPherson

Sampson

et al. 2017

Medical Education Online

107

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Background: Historically, medical students who are lesbian, gay, bisexual or transgendered (LGBT) report higher rates of social stress, depression, and anxiety, while LGBT patients have reported discrimination and poorer access to healthcare. Objective: The objectives of this study were: (1) to assess if medical students have perceived discrimination in their learning environment and; (2) to determine self-reported comfort level for caring for LGBT patients. Design: Medical students at the University of Ottawa (N = 671) were contacted via email and invited to complete a confidential web-based survey. Results: Response rate was 15.4% (103/671). This included 66 cis-gender heterosexuals (64.1%) and 37 LGBT students (35.9%). Anti-LGBT discrimination had been witnessed by 14.6% and heterosexism by 31.1% of respondents. Anti-LGBT discrimination most often originated from fellow medical students. Respondents who self-identified as LGBT were more likely to have perceived heterosexism (favoring opposite-sex relationships) (OR = 8.2, p < 0.001) or anti-LGBT discrimination (OR = 6.6, p = 0.002). While half of LGBT students shared their status with all classmates (51.4%), they were more likely to conceal this from staff physicians (OR = 27.2, p = 0.002). Almost half of medical students (41.7%) reported anti-LGBT jokes, rumors, and/or bullying by fellow medical students and/or other members of the healthcare team. Still, most respondents indicated that they felt comfortable with and capable of providing medical care to LGBT patients (≥83.5%), and were interested in further education around LGBT health issues (84.5%). Conclusion: Anti-LGBT discrimination and heterosexism are noted by medical students, indicating a suboptimal learning environment for LGBT students. Nonetheless, students report a high level of comfort and confidence providing health care to LGBT patients.

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Section: Introductionmentioning

confidence: 99%

Medical students’ perception of lesbian, gay, bisexual, and transgender (LGBT) discrimination in their learning environment and their self-reported comfort level for caring for LGBT patients: a survey study

Nama

MacPherson

Sampson

et al. 2017

Medical Education Online

107

View full text Add to dashboard Cite

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“…46,47 Yet, potential gains in health that accompany legal same-sex marriage are often discussed in the context of gay and lesbian adult populations and have excluded the children raised by gay and lesbian parents and the health issues important to children and pediatricians. [4][5][6][7][8]48 In a 2006 analysis commissioned by the AAP Board of Directors, 49 expanded access to employer-based health insurance was listed among the benefits that are conferred to children when their same-sex parents are allowed to marry. More recently, pediatricians and the AAP have endorsed marriage equality for same-sex couples.…”

Section: Discussionmentioning

confidence: 99%

“…We relied on a common strategy to identify same-sex couples on the basis of the relationship to the survey respondent and assuming that same-sex couples were gay, lesbian, or bisexual. [4][5][6][7][8] Missing from our analysis were samesex couples outside of the relationship with the primary respondent or samesex partners identified as unrelated adults rather than a husband, wife, or unmarried partner. Also missing were children of same-sex couples who were living outside of the household or who were not reported as the biological, adopted, or stepchild of the primary respondent.…”

Section: Discussionmentioning

confidence: 99%

“…27 Consistent with previous research using similar techniques to identify same-sex couples, we assume that these couples are lesbian, gay, or bisexual adults. [4][5][6][7][8]28 (Our identification strategy cannot ascertain transgender populations given the binary male-female categories on gender identity included in the survey).…”

Section: Data Sourcementioning

confidence: 99%

“…1,2 As a result, pediatricians should expect to encounter more children from gay and lesbian families in their practices. Although disparities in health and health care are well documented for gay and lesbian adults, [3][4][5][6][7][8] very little is known about the children living within their households. The large number of studies that do investigate the health and well-being of children with samesex parents disproportionately focus on the psychological and social development of children.…”

mentioning

confidence: 99%

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Disparities in Health Insurance Among Children With Same-Sex Parents

Gonzales

Blewett

2013

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Health insurance is associated with improved health for children, but gay and lesbian parents face barriers to adding their children to private health insurance. Little is known about the extent to which insurance disparities exist for children with same-sex parents. WHAT THIS STUDY ADDS:Children with same-sex parents are less likely to have private health insurance. When children live in states in which legal same-sex marriage, civil unions, domestic partnerships, or second-parent adoptions are available, disparities in private insurance diminish for children with samesex parents.abstract OBJECTIVES: The objectives of this study were to examine disparities in health insurance coverage for children with same-sex parents and to investigate how statewide policies such as same-sex marriage and second-parent adoptions affect children' s private insurance coverage. METHODS:We used data from the 2008-2010 American Community Survey to identify children (aged 0-17 years) with same-sex parents (n = 5081), married opposite-sex parents (n = 1 369 789), and unmarried opposite-sex parents (n = 101 678). We conducted multinomial logistic regression models to estimate the relationship between family type and type of health insurance coverage for all children and then stratified by each child' s state policy environment.RESULTS: Although 77.5% of children with married opposite-sex parents had private health insurance, only 63.3% of children with dual fathers and 67.5% with dual mothers were covered by private health plans. Children with same-sex parents had fewer odds of private insurance after controlling for demographic characteristics but not to the extent of children with unmarried opposite-sex parents. Differences in private insurance diminished for children with dual mothers after stratifying children in states with legal same-sex marriage or civil unions. Living in a state that allowed second-parent adoptions also predicted narrower disparities in private insurance coverage for children with dual fathers or dual mothers.CONCLUSIONS: Disparities in private health insurance for children with same-sex parents diminish when they live in states that secure their legal relationship to both parents. This study provides supporting evidence in favor of recent policy statements by the American Academy of Pediatricians endorsing same-sex marriage and second-parent adoptions. Pediatrics 2013;132:703-711

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Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity

et al. 2017

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and The Joint Commission recommend routine documentation of patients' sexual orientation in health care settings. Currently, very few health care systems collect these data since patient preferences and health care professionals' support regarding collection of data about patient sexual orientation are unknown.OBJECTIVE To identify the optimal patient-centered approach to collect sexual orientation data in the emergency department (ED) in the Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity study. DESIGN, SETTING, AND PARTICIPANTS An exploratory, sequential, mixed-methods design was used first to evaluate qualitative interviews conducted in the Baltimore, Maryland, and Washington, DC, areas. Fifty-three patients and 26 health care professionals participated in the qualitative interviews. Interviews were followed by a national online survey, in which 1516 (potential) patients (244 lesbian, 289 gay, 179 bisexual, and 804 straight) and 429 ED health care professionals (209 physicians and 220 nurses) participated. Survey participants were recruited using random digit dialing and address-based sampling techniques. MAIN OUTCOMES AND MEASURESQualitative interviews were used to obtain the perspectives of patients and health care professionals on sexual orientation data collection, and a quantitative survey was used to gauge patients' and health care professionals' willingness to provide or obtain sexual orientation information.RESULTS Mean (SD) age of patient and clinician participants was 49 (16.4) and 51 (9.4) years, respectively. Qualitative interviews suggested that patients were less likely to refuse to provide sexual orientation than providers expected. Nationally, 154 patients (10.3%) reported that they would refuse to provide sexual orientation; however, 333 (77.8%) of all clinicians thought patients would refuse to provide sexual orientation. After adjustment for demographic characteristics, only bisexual patients had increased odds of refusing to provide sexual orientation compared with heterosexual patients (odds ratio, 2.40; 95% CI, 1.26-4.56). CONCLUSIONS AND RELEVANCEPatients and health care professionals have discordant views on routine collection of data on sexual orientation. A minority of patients would refuse to provide sexual orientation. Implementation of a standardized, patient-centered approach for routine collection of sexual orientation data is required on a national scale to help to identify and address health disparities among lesbian, gay, and bisexual populations.

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Disparities in Health Insurance Coverage, Access, and Outcomes for Individuals in Same-Sex Versus Different-Sex Relationships, 2000–2007

Abstract: In the largest and most recent nationally representative sample, we found important differences in health insurance coverage and access to care between individuals in same-sex relationships and those in different-sex relationships for both men and women.

Cited by 309 publications

References 12 publications

Medical students’ perception of lesbian, gay, bisexual, and transgender (LGBT) discrimination in their learning environment and their self-reported comfort level for caring for LGBT patients: a survey study

Medical students’ perception of lesbian, gay, bisexual, and transgender (LGBT) discrimination in their learning environment and their self-reported comfort level for caring for LGBT patients: a survey study

Disparities in Health Insurance Among Children With Same-Sex Parents

Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity

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