In recent years, the federal government has made strides toward making healthcare more inclusive for the lesbian, gay, bisexual and transgender community.
The Affordable Care Act required marketplace plans to recognize same-sex marriages for tax purposes and this spring, Medicare began covering sexual reassignment surgery for transgender patients.
But these policy changes aren't necessarily translating to better care on the ground.
According to a recent Gallup survey, LGBT people are more likely to be uninsured than non-LGBT individuals. After the passage of the ACA, the uninsured rate of the LGBT community dropped from 24% to 17%. But among non-LGBT individuals, it fell even lower: from 17% to 13%.
LGBT adults are also less likely to have a primary care provider (particularly among women). They often report two major barriers to receiving care: cost and fear of discrimination. Media reports have borne that their fears are not unfounded—it is not uncommon to see stories of partners unable to visit loved ones in the hospital or transgender patients being turned away by a healthcare provider.
Meeting a population
It never benefits providers when a population is not seeking and receiving the care they need. Some hospitals have understood this is an issue with the LGBT community and are making changes.
The Human Rights Campaign began tracking hospitals' treatment of LGBT patients in 2007 with its Health Equality Index. Hospitals that meet guidelines in four core areas (patient and employment non-discrimination, equal visitation and training on LGBT patient-centered care) are awarded with the title Leader in LGBT Healthcare Equality.
Hospitals may have been slow on the uptake, but in the past two years, the number of organizations meeting the standards has skyrocketed. In 2013, 464 healthcare facilities met all four criteria. This was a 199% increase from the previous year. Only four states, Idaho, New Hampshire and both of the Dakotas, did not have at least one hospital on the list.
Some of the areas these hospitals focused on were providing insurance for sexual reassignment surgery to their own employees; creating LGBT advisory councils; allowing partner visitation rights equal to that of married couples and families; and ensuring their electronic medical records and paperwork were suited for various sexual orientations and identifications.
Chelsea Fullerton, program coordinator for the office of diversity affairs at NYU School of Medicine, said the system put a lot of focus on ensuring that NYU Langone Medical Center made the list two years in a row.
Their journey started with an advisory group that did an audit of what it would look like to be an LGBT patient in different areas of the hospital. They created a video to train hospital staff on terminology and care for LGBT patients. They are also working on getting new fields placed in their medical records system for sexual identity and gender. She said this will allow them to understand patients better, but also track patient care to understand why this population experiences disparate health outcomes.
In June, the hospital participated in the New York City Pride March for the first time. There were about 60 people from all over the hospital as well as patients who took part.
"We carried a banner that listed NYU Langone," she said. "We were able to send a message that we are inclusive and care about people. It is a visible commitment that we are dedicated to caring for them."
Improving care
Fullerton said there are a few things hospitals can do to start focus their diversity efforts toward the LGBT community.
First is to convene a group like the council at NYU. An effective group, she said, will include all levels of staff as well as patients. The best way to understand the kind of care the hospital is providing to this community is by speaking to a LGBT patient who was treated at the hospital. The committee should focus on finding the holes in the system.
A hospital can then create a model that works for the system. Such a model doesn't need to be created from scratch; There is literature on the issue and providers who specifically treat LGBT patients can help provide a blueprint.
The process will be ongoing, Fullerton said. As far as NYU has come, there is always room for improvement. She said she would like to see every staff member and affiliated group trained on LGBT care issues.
"We need to get to a place where everyone has basic training and knows where the hospital stands on this," she said. "It's a myth when it comes to the thought that, I'm providing care as long as I treat everyone the same. You are not doing your job as a provider because it ignores the beautiful spectrum of human experience that exists."