Even with health insurance, lesbian, gay and bisexual adults are more likely to delay medical care

Lesbian, gay and bisexual adults in California have rates of health insurance coverage on par with or better than that of straight men and women in the state, but they are more likely to wait to see the doctor when they need medical care, according to a new policy brief by the UCLA Center for Health Policy Research.

Why the delay? According to Susan Babey, a co-author of the study, one reason cited in other research is that sexual minorities sometimes experience discrimination when they seek health care.

"Sexual minorities who have had a bad experience with a medical provider because of their sexual orientation may try to avoid repeating it," said Babey, who is also co-director of the Chronic Disease Program at the center.

The UCLA study looks at differences in access to care, behaviors that negatively affect health (such as smoking or not exercising) and health problems that can result from those behaviors (such as developing hypertension or being overweight), based on people's sexual orientation. The findings show that 24 percent of bisexual men and 22 percent of straight men say they do not have a doctor they regularly see, compared with only 13 percent of gay men; but 20 percent of gay men and 21 percent of bisexual men delayed seeking health care in the past year, compared with 13 percent of straight men.

Thirteen percent of straight women and 15 percent of lesbians reported that they do not have a doctor they regularly see, while a higher percentage of bisexual women, 22 percent, said they do not have one. However, 29 percent of lesbians and bisexual women said they delayed seeking medical care in the past year compared with just 18 percent of straight women.

The study uses data from the combined 2011 to 2014 California Health Interview Survey. (Data on transgender people is not included because the survey only began collecting transgender data in 2015-16.) More than 1 million California adults, 4.5 percent of the state's adult population, identify as lesbian, gay, homosexual or bisexual, according to the survey.

Other key findings from the research:

• Bisexuals have the worst overall access to a doctor they see on a regular basis and high rates of unhealthy behaviors. Among lesbian/gay, bisexual and straight adults, bisexual men and women are the least likely to have a regular source of care, are most likely to delay care and are mostly likely to seek care in an emergency room. Bisexual men have higher rates of unhealthy behaviors in four of the five categories analyzed in the study. Among women, bisexuals in the study have higher rates of smoking and binge drinking, and are more likely to eat fast food two or more times a week.
• Gay men report better overall health and fewer behaviors that lead to obesity and hypertension than straight men. Sixty-one percent of gay men said they considered themselves to be in excellent or very good health, compared to 52 percent of straight men and 44 percent of bisexual men. Gay men are less likely to drink sugary beverages daily and were less likely to binge drink than straight and bisexual men. Twenty-seven percent of straight men in the study were obese, compared with 21 percent of gay men and 20 percent of bisexual men.
• Straight women have the best access to a doctor they see on a regular basis, overall health and the lowest rates of unhealthy behaviors. Half of straight women said they were in excellent or very good health, versus 44 percent of lesbians and 45 percent of bisexual women. Twenty-seven percent said they had engaged in binge drinking within the previous year, compared to 50 percent of bisexual women. Ten percent of straight women were smokers, compared with 23 percent of bisexual and lesbian women. Lesbians had the highest rate of obesity, 35 percent, compared with 26 percent of bisexual women and 24 percent of straight women.

"Our study shows bisexuals have among the greatest need for regular health care, but are the least likely to get it," said Joelle Wolstein, a research scientist at the center and the study's lead author. "Even if they have a high-quality insurance plan through an employer, health equity is far from a reality for many LGBTQ patients."