A Geographically Contextualized Examination of LGBT Inclusive Healthcare Organizations in the U.S.

Over the last twenty years, the United States has experienced significant changes in public opinion in support for LGBTQ (lesbian, gay, bisexual, transgender, and queer) people and issues. While at the national level high polling numbers suggest support for LGBTQ rights, U.S. states differ substantially in state level policies and protections against sexual orientation discrimination (American Civil Liberties Union [ACLU], 2021). Despite state level public opinion and political climate towards LGBTQ persons, there is often wide variation in LGBTQ legal protections and socio-political climates among municipalities within a state (Buchanan, 2019). Approximately, 35% of hospitals in the United States do not have LGBTQ non-discrimination policies nor have LGBTQ-inclusive practices and policies in place (Healthcare Equality Index, 2020). As a result, many LGBTQ persons are hesitant to disclose their sexual orientation to their health care providers and may avoid receiving healthcare due to concerns of discrimination or cost of care (Casey, et al., 2019). These barriers to care can lead to worse health outcomes for the LGBTQ population and being often overlooked in health disparities improvement efforts (IOM, 2011). This study extends the research of DiLeo et al. (2020) by examining additional market factors, specifically, states’ LGBTQ population and public policies at both the state and municipality levels that may influence a hospital’s voluntary pursuit of Health Equity Index (HEI) Leader status. The main finding of this study is that LGBT population and governmental public policies may influence a hospital voluntarily pursuing HEI Leader status but they may not be as influential as originally anticipated. Additional research is needed to better understand market factors that support hospitals voluntarily pursuing HEI Leader status. It may be that the hospital’s characteristics such as location (urban vs. rural), teaching status, and ownership, are more influential then market factors.