Preventing discrimination and improving care for the LGBTQ community

Disparities exist throughout the health care system. For members of the LGBTQ community, access to safe, affirming and inclusive care is too often hard to find.

Fifteen percent of LGBTQ Americans have avoided or postponed medical care due to discrimination, this includes nearly three in 10 transgender individuals. LGBTQ people of color are more than two times as likely to avoid the doctor’s office, potentially exacerbating racial disparities that already exist. This avoidance can lead to delayed diagnoses, missed care and poorer outcomes.

LGBTQ people also have unique health care needs that are often unmet in traditional settings. According to the National Association of Mental Illness, LGB adults are more than twice as likely as heterosexual adults to experience a mental health condition. Transgender individuals are nearly four times as likely as cisgender individuals to experience a mental health condition. Lesbian and bisexual females are more likely to be overweight or obese, and LGBT populations have the highest rates of tobacco, alcohol and other drug use. Additionally, one in three transgender patients note the unique obstacle of having to teach their care provider about transgender issues in order to receive appropriate care. Therefore, awareness around the specific needs of each individual LGBTQ patient is critical to provide high-quality, personalized care.

The Biden Administration recently announced protections against discrimination in health care based on gender identity and sexual orientation, which is good news. Many individuals fear they will receive differential treatment (73 percent of transgender and 29 percent of LGB) or be refused treatment (52 percent transgender and nine percent of LGB) based on their sexual orientation or identity.

In Rhode Island, Blue Cross & Blue Shield of Rhode Island (BCBSRI) has been working to ensure the LGBTQ community can find the care they need and navigate their health without fear of discrimination from their provider. Through the LGBTQ Safe Zone Program, BCBSRI is identifying health care practices, facilities and services that offer safe, affirming and inclusive care. The program certifies practices, facilities and services that meet each certification requirement, which reflect the highest standards of care for LGBTQ people.

“We know that great disparities still exist for our LGBTQ members in receiving equitable care,” said Matt Collins, M.D., MBA, executive vice president and chief medical officer at BCBSRI. "Making sure everyone has access to safe, appropriate and affirming care without fear of discrimination, judgement or abuse is vital to both maintaining and improving the health of LGBTQ Rhode Islanders." 

There are currently 34 unique BCBSRI LGBTQ Safe Zone practices and health services, all of which have met the certification requirements of staff training specific to the care of trans and LGB individuals within the last 12 months; protection from discrimination based on gender identity and expression for both patients and staff, as well as gender neutral restrooms, inclusive forms and procedures; and a public commitment to connecting with and serving the LGBTQ community.

BCBSRI began designating Safe Zones in 2016, focusing on a variety of care services including: dental, medical and behavioral health as well as substance use disorder, rape and sexual trauma and assisted living for older LGBTQ adults.

The certification reflects one of BCBSRI’s primary goals of advancing health equity in Rhode Island by fostering environments in which LGBTQ patients are directed toward safe, life-affirming care, while practices and health services offering said quality of care benefit from increased visibility within the LGBTQ community.

"If people are not seeking medical care, we cannot treat them,” added Collins. “By working to end discrimination and ensure staff is properly trained to address the specialized needs of our LGBTQ members, we can improve health and outcomes.”

Blue Cross Blue Shield of Rhode Island is an independent licensee of the Blue Cross Blue Shield Association.