LGBTQ Patient Perceptions of Healthcare Discrimination and Dissatisfaction: Associations with Physical Health Outcomes

Introduction
Lesbian, gay, bisexual, transgender, or queer (LGBTQ) patients experience significant health disparities due to experiences of discrimination, minority stress and stigma, and inequities in healthcare access. However, further research is needed to clarify nuances in the origin and maintenance of these disparities.

Methods
Participants from across the USA (N = 535; 30.4% LGBTQ) were recruited in 2020 using social media and completed online questionnaires investigating perceptions of and interactions with healthcare systems.

Results
LGBTQ participants reported worse physical health outcomes, as measured by somatic symptom burden and self-rated health, as well as higher levels of discrimination in medical settings and lower patient satisfaction. Regarding patient satisfaction, LGBTQ participants specifically reported lower overall satisfaction, satisfaction with financial aspects of medical care, and accessibility and convenience of healthcare compared to heterosexual and cisgender counterparts. Additionally, LGBTQ identity significantly moderated the relationship between discrimination in medical settings and somatic symptoms, such that participants who experienced higher discrimination and identified as LGBTQ reported significantly greater somatic complaints compared to their non-LGBTQ counterparts.

Conclusions
Current results demonstrate that structural inequalities in cost and accessibility seem to be driving observed differences in patient satisfaction. Furthermore, it is apparent that discrimination in medical settings is related to physical health outcomes and that this relationship is more pronounced for LGBTQ patients.

Policy Implications
Results indicate a need for policy changes increasing access and affordability measures for vulnerable populations, as well as incorporation of trauma-informed care, to reduce structural inequalities and promote non-discriminatory environments for all patients, including LGBTQ patients.