Individual and Systemic Barriers to Health Care: Perspectives of Lesbian, Gay, Bisexual, and Transgender Adults

Access to effective services is imperative to address the many health and mental health disparities that lesbian, gay, bisexual, and transgender (LGBT) people face. This population, however, remains underserved and often ill-served in health care environments. Furthermore, interactions between system- and individual-level dimensions of access create barriers to service engagement. Within much of the extant literature surrounding health care barriers among LGBT people, the rich narratives and varied experiences of LGBT community members from diverse backgrounds have often been excluded. The current interview-based study was conducted with a sample of 40 self-identified LGBT adults living in New York City. Participants were recruited through flyers distributed to LGBT-specific social and health service organizations. Twenty-nine participants who discussed health care access as a major health concern were included in the current study. Framework analysis revealed barriers stemming from characteristics of services and providers (system-level) and characteristics of care-seekers (individual-level) as major health concerns. The root causes of system-level barriers were all attributed to social-structural factors that worked to exclude and erase LGBT people from the institutions that shape the health and mental health systems. Individual-level barriers were attributed to both individual and social-structural factors, such as health literacy and stigma. Participants linked access barriers to forgone care and to other health and mental health concerns within their communities. We argue that addressing barriers at the individual and sociostructural levels will better serve LGBT communities. Public Policy Relevance Statement Access to health and mental health services is a major health concern among LGBT community members. The LGBT population experiences poor health and mental health outcomes related to barriers to care. Policies set forth by the Patient Protection and Affordable Care Act (e.g., nondiscrimination protections, expanded insurance coverage) remain important initiatives to promote equitable health care access and enhance the health and wellbeing of LGBT care-seekers.