Transforming Institutions:
Undoing Erasure in Health Care
Health care is a human right.
Health Justice requires undoing legacies and layers of transphobia, racism, xenophobia, sexism, and ableism in medicine and health care practices. This requires more than simply improving providers’ competency to work with trans patients. Health justice is acknowledging and repairing the harms caused by the imposition of binary sex and gender norms in medicine.
Health justice is the full recognition of health care as a human right. This requires institutional policies and protections that increase safety, choice, autonomy, and dignity in accessing health care. It also means investing in diverse forms of health knowledge and care practices.
This page provides data related to survey participants’ access to and use of existing health care systems in Los Angeles County.
TMSHRJ:LA survey participant
Intersecting Barriers To Care
reasons for delaying care
We asked participants if they had delayed care in the past year. Participants could select multiple reasons and write in reasons that they had delayed care. (They could also say that they had not delayed care in the past year).
Many participants said they lacked trust in health care providers, had anxiety related to bad experiences in the past, and were concerned about mistreatment due to transphobia, mental health stigma, racism, xenophobia, and/or fatphobia. Economic barriers were significant even among those who had health care insurance. Among the top reasons participants said they had delayed care included costs and not being able to take time off work for health care appointments.
......based on gender identity or expression
* Asked to BIPOC only.
- difficulties navigating my health insurance
- problems with health insurance
- lack of communication between the doctors and my insurance
- cannot find trans knowledgeable providers covered by my insurance
- lack of appropriate transgender related care under insurance
- disbelief that dr could treat my symptoms
- fatphobia is real. Everything always comes back to my weight. Lots of fat shaming.
- anxiety around weight/ fat-shaming
- fear of possible diagnosis
- no clinics in the area
- recently moved to LA and don’t know about safe healthcare providers here
- availability of appointments
- trauma from an abusive ex
All participants who said they had delayed health care because they lacked stable housing were Black, Indigenous, People of Color (BIPOC). A greater portion portion of white participants said they delayed care to avoid physical exams compared to BIPOC participants.
DELAYED CARE DUE TO LACK OF HOUSING
DELAYED CARE TO AVOID PHYSICAL EXAMS
TMSHRJ:LA survey participant
ACCESS TO HEALTH CARE INSURANCE
SOURCES OF COVERAGE
We asked participants if they had health insurance and if so, WHAT WAS their CURRENT source(S) of insurance.
Public heath insurance is vital to health equity for Transmasculine people. Less than 40% had a employer-sponsored health insurance plan. Most participants were low income and many worked part-time jobs and/or in gig- or cash- employment markets. Although some Transmasculine people had access to a parent’s or partner’s health insurance plan, being a dependent can jeopardize access to full medical autonomy.
A greater portion of participants who immigrated to the United States did not have health insurance when compared to participants who were not immigrants. The vast majority of participants who had immigrated to the US were BIPOC.
DOES NOT HAVE HEALTH INSURANCE
TMSHRJ:LA survey participant
Quality of care
experiences in medical setting
We asked participants to evaluate their experiences with medical providers in the past three years. this included experiences directly related to gender but also overall quality of care.
Felt comfortable talking about their gender identity:
- 29% - Often
- 37% - Sometimes
- 23% - Rarely
- 11% - Never
Felt providers trusted their knowledge about my health needs:
- 33% - Often
- 44% - Sometimes
- 19% - Rarely
- 4% - Never
Were satisfied with the care they received:
- 40% - Often
- 49% - Somtimes
- 13% - Rarely
- 2% - Never
1 in 4 BIPOC participants felt that providers rarely or never trusted their knowledge about their own medical needs compared to about 1 in 6 white participants.
PROVIDERS RARELY OR NEVER TRUSTED THEIR KNOWLEDGE ABOUT THEIR OWN MEDICAL NEEDS
TMSHRJ:LA survey participant
Access to primary care
Usual sources of care
We asked participants about whether they had a primary care provider (PCP) and where they Typical sought care.
- 25% – a Kaiser Permanente provider*
- 23% – Private doctor's office
- 22% – LA LGBT Center*
- 20% – St. John's Well Child & Family Center*
- 8% – A school or college clinic
- 7% – Children's Hospital LA*
- 7% – Planned Parenthood
- 6% – Traditional or spiritual health
- less than 2% said an LA public health center
- 18% – Urgent care clinics
- 10% – Emergency rooms
- 9% – No usual source of care
* HAS A transGENDER health program.
Nearly 1 in 3 BIPOC participants did not have a primary care provider (PCP) compared to less than 1 in 5 white participants.
DID NOT HAVE A PRIMARY CARE PROVIDER
EMERGENCY & URGENT CARE Use
We asked participants if they had used an urgent care clinic or emergency room in the past year. Emergency room visits may be an indicator of reduced access to primary and preventive health care services.
TMSHRJ:LA survey participant
KEY TAKEAWAYS
OUr partners
