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Column | Leadership

The pandemic isn’t the only reason for deferred care: Many transgender adults regularly forego care due to discrimination in healthcare settings

Column | Leadership

The pandemic isn’t the only reason for deferred care: Many transgender adults regularly forego care due to discrimination in healthcare settings

Image of Tammie Jackson

Tammie Jackson

The latest pandemic surge has created material bed shortages in many areas and furthered an already severe labor shortage. As a result, many facilities are again delaying elective procedures and augmenting other healthcare protocols. 

The Winter 2020 hfm cover story “Where did our sickest patients go?” explored the ramifications of deferred care due to the pandemic. As an industry, we've done much to remedy the problem. We’ve deployed telehealth, implemented processes to screen people before they enter the building, augmented care settings to minimize the number of people in waiting areas and so much more. 

But what about patients who defer care for reasons other than the pandemic? Will we work as hard to remove those barriers to care? 

A recent episode of HFMA’s “Voices in Healthcare Finance” podcast focused on equitable care issues faced by transgender adults. It featured Rodrigo Heng-Lehtinen, executive director of the National Center for Transgender Equality, who pointed out that nearly 25% of trans adults forego care due to discrimination in healthcare settings. For them, deferring care is not just a pandemic problem.  

Heng-Lehtinen highlighted a privilege I've admittedly always taken for granted: My identity documents match my outward appearance. At important junctures of my life — enrolling in school, applying for a job or a mortgage, presenting for care — the name and gender on my driver’s license, birth certificate and health insurance card all matched. It never occurred to me that these documents, and the ability to change them, are all governed by different rules. It also never occurred to me that, even if feasible, letters from a therapist and exorbitant fees may be required to change them. As a result, many trans adults go about their lives having to explain, justify and validate their own identity. 

Heng-Lehtinen noted that only 11% of trans adults have 100% updated documents. And when presenting in healthcare waiting rooms, one-third of them have had a negative experience, but more than that one-third fear the experience. As a result, they defer care until it becomes untenable. Of course, we all know this results in higher cost of care and poorer outcomes. 

We can help promote health equity in straightforward ways. We can add fields to patient intake systems, enabling us to sort through these more complex situations. We can ask what the name and gender on the health insurance card are. We can also ask if it matches the name on a driver’s license or even if it is the preferred name. There may be an upfront investment, but it will streamline the rest of the process. 

Something more practical and easier to deploy is sensitivity training. It’s important that frontline staff be mindful about information shared in a public waiting room. Think about it. When calling out a name that may not match someone’s outward appearance, we are outing them in front of an entire waiting room. It should be no surprise that experience will force many to avoid going to the doctor. 

These are simple things we can do to promote health equity and meet people where they are. If we're well intended, we can't help but find such opportunities. Continue to be bold in these efforts. We can forge a brighter path forward for a better tomorrow. 

About the Author

Tammie L. Jackson, FHFMA, CHFP, MHA,

is Chief Growth Officer at nThrive and National Chair, HFMA. 

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