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Health systems show progress in equality for LGBTQ+ patients, workers


The 15th edition of the Healthcare Equality Index shows most healthcare organizations have strong non-discrimination policies. But some hospitals still have some work to do.

More healthcare systems are improving when it comes to equality and inclusion for LGBTQ+ patients and employees, but a new report shows some organizations have some work to do.

The Human Rights Campaign Foundation just released its 15th annual Healthcare Equality Index, a report on health system policies and practices relating to LGBTQ+ workers and patients. The foundation said 906 healthcare facilities participated in the survey, including 176 facilities who took part for the first time.

Tari Hanneman, director of the health and aging program for the Human Rights Campaign Foundation, said she was heartened to see so many new participants amidst the COVID-19 pandemic. “I think it speaks to more and more interest in this issue,” Hanneman said.

More than four out of five participating facilities (82%) were designated as “leaders” or “top performers.”

The foundation evaluated healthcare organizations in four categories: foundational policies and training; LGBTQ+ patient services and support; employee benefits and policies; and patient and community engagement.

Related story: Why inclusion may be more important than diversity

Nearly all (99%) of the participants in the HEI survey include both “sexual orientation” and “gender identity” in their non-discrimination policies for patients and employees.

However, a study of hospitals who did not participate had less encouraging results, the foundation said.

The HRC Foundation examined more than 1,300 non-participating hospitals and found they were less likely to have LGBTQ+ policies in place. Only 70% of the systems include both sexual orientation and gender identity in their patient non-discrimination policies.

In addition, most hospitals don’t offer medical benefits to domestic partners of employees. Hanneman said that’s a problem because some same-sex couples live in states where workplace protections against discrimination don’t include sexual orientation.

Some healthcare workers “live in a state where they can get fired for being gay,” she said. “Asking them to get married so a partner can get benefits is not optimal.”

Healthcare organizations that implement policies to support LGBTQ workers and patients are doing the right thing and making good business decisions, Hanneman said. Typically, those facilities faring well in the HEI report also have higher patient satisfaction. “There’s a good return on investment,” she said.

Hospitals with strong support for LGBTQ workers also gain an advantage in recruiting and retaining employees.

“If someone feels like they can be their whole selves at work, that they don’t have to hide a part of themselves, it makes them want to be part of an organization that is making that effort,” Hanneman said.

As hospitals focus on improving health equity across racial and ethnic groups, Hanneman urged systems to use an “intersectional lens” to consider LGBTQ+ patients. “Remember that LGBTQ people are going to fall along all of those spectrums,” she said.

While hospitals are making great strides in equality, Hanneman said she’d like to see the healthcare industry play a more vocal role in opposing anti-LGBTQ legislation being proposed at the state level. Some large corporations have stood up to fight against those bills.

“We haven’t seen that same level of engagement from our hospital and healthcare facility partners,” Hanneman said.

The foundation also faulted two Texas hospitals - UT Southwestern Medical Center and Children’s Health in Dallas - because they stopped providing medically approved care to transgender youth, even as they continued to provide the same care for cisgender youth. The foundation noted the closure of the GENECIS clinic that served transgender youth; it was jointly operated by the two organizations. The hospitals also said they would stop new prescriptions for hormone therapy and puberty blockers for transgender youth patients.

Texas Gov. Greg Abbott has directed state agencies to investigate medical treatments for transgender youths as “child abuse,” drawing outrage from medical professionals and LGBTQ+ advocates. The American Medical Association and the American Academy of Pediatrics, among other groups, support gender-affirming healthcare models, as Time notes.

The HEI survey found that 81% of hospitals offer transgender-inclusive healthcare benefits to their workers, up from 75% in 2019.

The report recognized 496 healthcare organizations as leaders, the highest honor, while 251 were named top performers.

Here are some other noteworthy findings from the HEI report.

Patient services

  • 82% provide some specific services aimed at transgender patients
  • 81% can capture a patient’s sexual orientation in their electronic health records
  • 74% have a plan for reducing health disparities that specifically includes LGBTQ+ patients
  • 47% have a LGBTQ+-focused office, point person or patient advocate
  • 26% have an externally promoted program to provide patient navigation or advocacy services for transgender patients

Employee policies

  • 34% offer medical and health benefits to domestic partners of employees who are eligible for benefits
  • 41% offer benefits allowing workers to take family leave to care for same-sex partners or the children of same-sex partners
  • 59% have a recognized LGBTQ+ employee resource group
  • 76% have one or more openly LGBTQ+ employees serving in visible leadership roles
  • 87% have an office or working group focused on diversity that includes LGBTQ+ diversity in its mission

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