Analyses of data from a large, nationally representative sample of U.S. adults confirms findings from smaller-scale studies suggesting that lesbians are disadvantaged in terms of health care access; gay men do not appear to be similarly disadvantaged.1 Women living with a female partner are less likely than those living with a man to have health insurance coverage, to have seen a health professional in the past year and to have a routine source of care; they have increased odds of having unmet medical needs because of cost issues. By contrast, men living with a male partner are significantly more likely than those living with a woman to have made a recent health care visit, but the two groups do not differ on the other measures of health care access that were examined.
The analyses were based on data collected for the National Health Interview Survey between 1997 and 2003; they included 614 respondents aged 18–64 who were living with a partner of the same sex and 93,418 who were living with a partner of the opposite sex when interviewed. Relationships between health care access and a wide range of variables that might affect it were examined in descriptive and logistic regression analyses. All analyses were conducted separately for females and males.
Women and men living with a same-sex partner were significantly younger and better educated than those living with a partner of the opposite sex; they were substantially less likely to have children living with them. Women living with a male partner were less likely than those living with a female to be employed. More than three-quarters of each group of women and men were white, but for women, the proportion was significantly higher among those with a same-sex partner than among those living with a man. In most other respects, background characteristics did not differ within gender by type of partner. The vast majority of respondents had yearly incomes of $20,000 or more, roughly half had never smoked cigarettes and more than two-thirds considered themselves to be in excellent or very good health.
In analyses controlling for all background characteristics, women living with a woman had significantly reduced odds of having health insurance (odds ratio, 0.6), of reporting a health care visit in the previous year (0.7) and of saying that they had a usual source of care (0.5); their odds of having forgone medical care in the past year because of cost issues were nearly twice those of women living with a male partner (1.9). Men who lived with a male partner had significantly elevated odds of having seen a health care provider in the last year (1.6); they had marginally elevated odds of reporting a usual source of care, and did not differ from men living with a female partner with regard to health care coverage or unmet medical needs.
Among both women and men, a significantly larger proportion of those living with a member of the opposite sex than of those who had a same-sex partner said that their partner had health insurance. The proportion of those with private insurance who reported that they were the policyholder was significantly higher among those with a same-sex partner than among those with a partner of the opposite sex; this difference was considerably more marked among women (83% vs. 40%) than among men (88% vs. 76%).
The analysts caution that their results may not apply to individuals not living with a partner and may have been influenced by unmeasured factors. Nevertheless, they contend that their findings "highlight the relevance of sexual orientation to health care access in the United States." They note the "important disparities" in health care access between women living with a female and those living with a male partner, and speculate as to why similar disparities do not exist among males. For instance, they suggest, the HIV epidemic may have changed gay men's approach to the health care system, and levels of dissatisfaction with health care may be higher among women than among men in same-sex relationships.
In addition to calling for "improved cultural competence" among providers who serve gay, lesbian and bisexual patients generally, the analysts "encourage the development of outreach programs aimed toward the lesbian community to improve this population's regular use of health services."—D. Hollander
1. Heck JE, Sell RL and Gorin SS, Health care access among individuals involved in same-sex relationships, American Journal of Public Health, 2006, 96(6):1111– 1118.