Bay Area Reporter - December 7, 2006
Heather Cassell, h.cassell@ebar.com

"Many sectors in healthcare have come to recognize that there are health disparities experienced by distinct populations," said Joel Ginsberg, executive director of San Francisco-based GLMA. "The idea that LGBT people have unique health needs and experience specific health disparities is one that is now only becoming more generally understood by administrative healthcare"

With the rising awareness of queer healthcare needs, particularly related to gender identity, Ginsberg said that it was a "natural idea" to rate hospitals to push LGBT healthcare and healthcare worker's needs further into public consciousness, especially with access to and receiving quality healthcare in general increasingly being a public concern.

One of the biggest concerns for the LGBT community regarding healthcare is disclosure. "We face barriers to care which often have to do with fear of disclosure or having been treated insensitively or being discriminated against or not knowing where you can go and be out and honest about who you are," said Ellen Kahn, director of the Family Project at HRC.

One of the goals of creating the Healthcare Equality Index is to break down the barriers so people can freely go to the hospital or their doctor without fear of being discriminated against for being honest about who they are.

"Part of what we are trying to do is remove those barriers and open doors so that people aren't going to wait. They aren't going to delay routine care or screening or avoid going to the doctors or go to the hospital," said Kahn.

HRC President Joe Solmonese said the hospital rating survey, which he discussed in an interview with the Bay Area Reporter in May, is important.

One of the main benefits, he said would be the initiation of a dialogue with America's hospitals about LGBT healthcare issues and hospital employees. This will be done by measuring the quality of LGBT patient care and employee policies at 1,000 of the largest hospitals in the United States.

The hospitals selected for the initial survey each have over 300 beds. Selecting by the number of beds enabled diversity by casting a wide net among the hospitals from rural, suburban, and urban areas and including university, private, pub HRC President Joe Solmonese. Photo: Rick Gerharter lic, and religious-affiliated hospitals.

Solmonese also noted the collaboration with GLMA.

"I'm very excited to be working with them. It's not just an important collaboration for us, but an important collaboration for the community," he said.

Neither HRC not GLMA would confirm the estimated cost of the project or how the index was being funded. When pressed by the B.A.R. Kahn said, "It's people who are invested in GLBT equality who are allowing us to do this. The primary expenditure is coming out of our budget, but all of us are contributing our time and our talents and utilizing our networks."

The survey is due next spring.

Providing overview

The Healthcare Equality Index won't provide information about the quality of LGBT healthcare and policies at specific hospitals in the initial publication of the results, but it is hoped that, similar to the Corporate Equality Index when it was first launched, the information gathered will provide a general overview of LGBT healthcare and policies in the hospital industry as well as provide an incentive for more hospitals to participate.

"We took an approach that is sort of a little bit of a softer," said Kahn. "We are trying to engage hospitals in a way that's not putting them in a defensive position or feeling like something is coming out of the blue."

She hopes that by making this decision HRC and GLMA will receive positive responses through hospital participation, especially since this is the first time a survey like this has been done.

"I think what we're looking at, at least initially out of the gate, is sort of the broader things: Are there policies in place? Are there general sort of protections for GLBT patients? What is the extent to which their discussion in training and education of staff? It is a baseline measure and that's definitely what it's intended to be," Kahn said.

According to the Kaiser Family Foundation, the most recent estimate of national expenditures for healthcare was nearly $1.9 trillion in the United States in 2004.

With an estimated 8.8 million queer people living in the United States, Ginsberg pointed out, "It's a very large piece of the economy and to the extent that healthcare is acting in ways that recognize the unique and legitimate needs of LGBT people, that's a big part of society."

After the initial year it is anticipated that the Healthcare Equality Index will become institutionalized and the scope will extend to other sectors of the healthcare industry.

"The hope is that over the years it's going to become institutionalized and all the wheels are spinning," said Kahn. "It made sense to start with hospitals because we all have to deal with hospitals."

Later surveys could include long-term care facilities, nursing homes, hospices, and community health clinics.

The Healthcare Equality Index will not address specific health concerns of LGBT people during the first year. According to a report by the Williams Institute at the University of California, Los Angeles that was released December 1 and focused on HIV-positive patients' access to medical care, the study found that medical professionals and caretakers were systematically denying care to HIV-positive patients in three medical fields: skilled nursing facilities, obstetricians, and cosmetic surgeons in Los Angeles County.

The study stresses the need to monitor and educate the hospital industry, medical professionals, and caretakers, as well as healthcare consumers, which is the goal of HRC's and GLMA's partnership. After the first index is released, Kahn and Ginsberg hope that hospital industry professionals will tap into their extensive resources to ask for professional training, policy and procedure guidelines, and other forms of support to make their institutions more LGBT supportive and friendly for patients and employees.

Some hospitals are responding positively to the survey. San Francisco General Hospital is working on filling out the survey by the December 31 deadline, according to spokesman Anson Moon.

Alfreda Rooks, coordinator of the Comprehensive Gender Services program at the University of Michigan Health System in Ann Arbor, Michigan, which has an extensive teaching and medical practices and policies that are LGBT friendly and proactive, said the survey provides an "opportunity to show that we do take provider care very seriously and are reflective of our patient population and community."

"The survey is going to be a vehicle of change for the institution," said Dr. Jason Snyder, associate medical director of Grady Memorial Hospital's primary care center in Atlanta, Georgia and a member of GLMA. According to Snyder, Grady Memorial currently doesn't have best practice policies for queer patients and employees in place.

The Healthcare Equality Index is available online at http://www.hrc.org/Template.cfm?Section=Health1&Template=/TaggedP age/TaggedPageDisplay.cfm&TPLID=23&ContentID=24336.

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