Commentary on Sexual Orientation and Cost-Related Health Care Deferral
“SGM people are caught in a catch-22 for health care: defer care to avoid immediate costs and likely medical debt but have worse health that requires more costly care in the future.”
Emily Lupez, Assistant Professor of Medicine, and Carl G. Streed Jr, Associate Professor of Medicine and Research Director for the GenderCare Center, were invited to write a commentary on the research article “Sexual Orientation and Cost-Related Health Care Deferral” by Balshi et al. Drs. Lupez and Streed call attention to the research’s finding that sexual and gender minority (SGM) adults ability “to access health insurance has not resulted in being able to financially access health care.”
They note that “these results are made more alarming as they remained significant even when accounting for differences in sociodemographic factors, such as income and insurance, as well as self-reported health care status, a proxy for health care needs.” They point out how deferring care due to costs despite insurance coverage reflects an imbalance in costs and ability to pay for SGM populations specifically. Drs. Lupez and Streed note that these increased costs of care could be the result of “various well-documented disparities in physical and mental health conditions” and “unique health care needs of SGM people that are frequently excluded from insurance coverage.”
Drs. Lupez and Streed contextualize these findings further by noting that “the economic fortunes of SGM people are not equivalent to their straight, cisgender peers,” and “when seeking health care becomes critical, SGM people are faced with the difficult choice of facing serious health consequences from continuing to defer care or accumulating medical debt.” They add, “These individual decisions by SGM people are not made in a vacuum but reflect the environments in which they seek care.”
Drs. Lupez and Streed note that “addressing the economic disparities and burdens in health care for SGM people will require a broader undertaking that must (1) improve access to routine and preventive care, (2) eliminate exclusionary policies affecting care frequently used by SGM people, and (3) expand the health care workforce, particularly in mental health, to meet the needs of the population.”
They conclude, “At a time when we could be saving public and private dollars by paying for an ounce of prevention, we will soon get the bill for a pound of cure.”