National Healthcare Disparities Report - LDI Health Economist

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Priority Populations criminal justice, and identity documents. The health findings are presented here. More extensive demographic and methodological information can be accessed in the original report, Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Access to Health Care A majority of study participants sought care through a doctor’s office (60%); however, a significant minority used health centers and clinics (28%). Chapter 10 Figure 10.1. Primary source of medical care, LGBT population, 2008 100 Primary Source of Medical Care for Respondents 90 80 70 60 60% 50 40 30 20 17% 10 0 4% ER Doctor’s office Health center 7% Free clinic 4% VA 2% Alternative provider Source: Reprinted from the National Transgender Discrimination Survey Report on Health and Health Care, 2011. Four percent of respondents primarily used emergency rooms (ERs) for care. Several studies have shown that individuals who use ERs for primary care experience more adverse health outcomes than those who regularly see a primary physician. x Factors that correlated with increased use of ERs were: n Race—17% of African Americans used ERs as did 8% of Latino/a respondents. n Income—8% of respondents earning under $10,000 per year used ERs. n Employment status—10% of unemployed respondents and 7% of those who had lost their jobs due to bias used ERs. n Education—13% of those with less than a high school diploma used ERs. Visual conformers xi and those who had identity documents that matched their presentation had the highest rates of using doctor’s offices for their care. x For example, Foraselli P, DeAngelis C, Kaszuba A. Compliance with followup appointments generated in a pediatric emergency room. Am J Prev Med 1985;1(3); Chande VT, Krug SE, Warm EF. Pediatric emergency department utilization habits: a consumer survey. Pediatr Emerg Care 1996;12(1). xi Visual conformers are defined as respondents who believed their presentation matched their gender identity. This study notes the significance of visual nonconformity as a risk factor in eliciting antitransgender bias and its attendant social and economic burdens. 242 National Healthcare Disparities Report, 2011
Priority Populations Discrimination by Medical Providers Denial of health care and multiple barriers to care are commonplace in the lives of transgender and gendernonconforming people. Subjects in our study seeking health care were denied equal treatment in doctor’s offices and hospitals (24%), in ERs (13%), in mental health clinics (11%), by EMTs (5%), and in drug treatment programs (3%). xii Female-to-male (FTM) respondents reported higher rates of unequal treatment than male-to-female (MTF) respondents. Latino/a respondents reported the highest rate of unequal treatment of any racial category (32% by a doctor or hospital and 19% in both ERs and mental health clinics). Figure 10.2. People who were refused medical care, by race and gender identity 50 Refusal to Provide Medical Care by Race Refusal to Provide Care by Gender Identity/Expression 50 Chapter 10 45 40 35 36% 45 40 35 30 27% 30 25 20 15 19% 15% 19% 22% 17% 25 20 15 22% 19% 19% 10 5 0 Overall Sample American Indian Asian Black Latino/a White Multiracial 10 5 0 6% MTF FTM All Trans GNC Source: Reprinted from the National Transgender Discrimination Survey Report on Health and Health Care, 2011. Respondents were also asked whether they had been denied service altogether by doctors and other providers. Nineteen percent had been refused treatment by a doctor or other provider because of their transgender or gender-nonconforming status. Twenty-two percent of MTF respondents reported having been refused treatment altogether, and 19% of FTM respondents did. Respondents who had lost jobs due to bias (36%); those who engaged in sex work, drug sales, or other underground economies for income (30%); those on public insurance (28%); and those living full time as their gender identity (25%) experienced high occurrence of refusal to treat. xii These results were based on a question prefaced by: “Based on being transgender/gender non-conforming, please check whether you have experienced any of the following in this public space,” and asked respondents to indicate whether they had been “denied equal treatment of service” for each of the various locations. National Healthcare Disparities Report, 2011 243
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