LGBT health care movement gains momentum
by Heather Cassell
Fifty years after the late Evelyn Hooker, Ph.D., published her first studies in the Journal of Psychology showing that there were no mental health differences among gay men and heterosexual men that kicked off the LGBT health movement, advocates' efforts are emerging to provide tangible information that consumers and medical providers can use to push for quality care and information for the queer community.
Earlier this month, the Human Rights Campaign, in partnership with the Gay and Lesbian Medical Association, released the inaugural Healthcare Equality Index, giving LGBT people and health care providers a tool to assist them with navigating care at hospitals.
While the first report is small – only 30 surveys representing 78 hospitals in 20 states and the District of Columbia were returned by hospitals or health care organizations out of 1,000 surveys distributed – HRC and GLMA were pleased that the index marks a starting point. HRC and GLMA sent the survey to hospitals with more than 300 beds.
"This represents ... a recognition by both private and public hospitals that it's time to ... address the needs of [the] LGBT population [as] just part of what it means to provide quality care," said Joel Ginsberg, executive director of GLMA.
Similar to HRC's Corporate Equality Index, which tracks corporations' LGBT policies, the Healthcare Equality Index addressed five important areas identified by LGBT health care consumers: patient non-discrimination, visitation, decision-making, cultural competency training for staff, and employment policies.
"This report really gives us a baseline snapshot look at where the hospital industry is in general on these key issues," said Ellen Kahn, director of HRC's family project.
Ratings for individual hospitals and health care organizations weren't revealed in the first index in order to encourage hospital participation, Kahn said. Future indexes will include hospital and health care organization rankings. HRC and GLMA didn't research the policies of hospitals that opted not to participate this first time around, Kahn said, but it's something the two organizations are considering doing for the next index.
Sixty percent of the responding hospitals reported having sexual-orientation non-discrimination policies in place, according to the Index, while 46 percent included gender identity policies.
Ginsberg and Kahn agreed that while they were both satisfied by the level of participation in the initial survey, there were clear indicators for improvements, in particular with meeting transgender individuals' health care needs. According to the report, in some cases paramedics ceased treatment upon realizing patients were transgender and that some health care providers refuse to treat transgender patients.
Half of the hospitals had a written policy allowing LGBT domestic partners the same access to their partner as heterosexual spouses and next of kin. Fifty-seven percent of the hospitals had LGBT cultural competency training for hospital staff. Seventy-three percent of the hospitals recognized advanced health care directives and durable powers of attorney, while 45 percent of hospitals allowed same-sex partners to make health care decisions and visitation rights for their children the same as opposite-sex parents.
Estimated health care expenditures in 2006 were $2.16 trillion, that's $7,110 per person annually, according to a report by the Henry J. Kaiser Family Foundation in May 2006. Health care expenditures are projected to be $4 trillion, an estimated $12,320 per person, by 2015, the report stated.
With an estimated 8.8 million LGBT people living in the United States, Ginsberg said last December, "It's a very large piece of the economy and to the extent that health care is acting in ways that recognize the unique and legitimate needs of LGBT people, that's a big part of society."
Kahn agreed. "There is a market incentive here, whether they are considered nonprofit or for-profit you need to have your share of the population that resides within your community."
The index is already making an impact at other hospitals, according to Ginsberg. After completing the survey, a Chicago hospital revised its LGBT policies and procedures in order to obtain a better score on the next index, Ginsberg said.
Anson Moon, a hospital planner and an administrator for San Francisco General Hospital, completed the survey last December. While he hadn't seen SFGH's rating from HRC, he told the Bay Area Reporter he was confident that SFGH ranked well. Moon said that the hospital made some minor internal adjustments after the survey was completed.
Surveys for the next index have already been sent out, Kahn said. The next index will include ratings of individual hospitals and health care organizations and will be available by spring 2008.
"We are quite confident that we'll have a huge increase in the number of hospitals that will submit a survey," said Kahn, who is working with a broad coalition of advocates and networks to get the survey in front of hospital administrators.
Kahn told the B.A.R. that the next step for the index is to add a survey for long-term health care facilities to address the growing needs of an aging LGBT community. She expects to incorporate surveys for specific health care organizations from hospices to community health clinics to other branches in the health care industry as the index develops.
"This puts this issue on the radar for other folks who are responsible for delivering services in a health care setting," said Kahn. "So it may not be that those folks will be surveyed and scored within the next two or three years, but ... there is a definite sort of changing of the landscape when you raise the dialogue around these issues and raise the visibility."
Be your own advocate
At the same time the index is a tool for change in the hospital industry, Ginsberg also believes individuals need to be their own advocates. To fulfill this role, the index includes important health care consumer information to assist LGBT individuals with navigating providers.
"It's important that individuals arm themselves with the information that they need, that they know their rights, and they ask for what they want and what they need," said Ginsberg. "Only by pursuing both strategies, encouraging institutional change and encouraging ... and empowering individuals to ask for what they want will we end up with quality care for LGBT people."
Some of the information in the index includes health care directives and other necessary legal documents for LGBT families and friends, as well as information about the Health Insurance Portability and Accountability Act, commonly known as HIPAA. The federal law enacted in 1996 established national privacy standards for releasing patients' information.
The information gathered by HRC and GLMA will be available as an online resource for consumers to search for health care facilities in the future, said a GLMA news release. GLMA's online provider directory, which is separate from the index, is currently in the process of being updated and should be re-launched next month, Ginsberg said.
Doctor check up
GLMA also will be giving U.S. doctors a LGBT check up in 2008 with the help of the American Medical Association. The AMA provided a $100,000 grant to GLMA last month for the organization to survey doctors about their attitudes toward LGBT patients and their knowledge of LGBT heath care issues.
"This [is] recognition that LGBT people have come into their own with health," said Ginsberg. "This is a maturing of LGBT health as a group for equality and civil rights."
The importance of the survey, Ginsberg said, is to get "definitive information about what U.S. physicians know and don't know about their LGBT patients and what their attitudes are about those patients" in order to develop cultural sensitivity training materials to improve LGBT individuals' quality of health care.
"The AMA is glad to be partnering with GLMA on this important project," said Dr. Andrew Gurman, AMA board member. "We are encouraged that by doing so we will better understand how to provide our lesbian, gay, bisexual, and transgender patients with high quality care."
Because almost all doctors have relationships to hospitals, Kahn noted, she believes GLMA's survey will provide "a real clear direction" to identify educational and programmatic information and will add to the health care index.
Doctors should expect to receive the survey sometime in January, Ginsberg said. The results of the survey should be available late next year.
"When we look back ... this new partnership with the AMA and this work that we are doing with HRC will be seen as a watershed moment for full equality in health care for LGBT people," said Ginsberg.
To download the Healthcare Equality Index, visit www.hrc.org/issues/7645.htm.