Lesbian, gay, bisexual, transgender and queer adults are twice as likely as their non-LGBTQ counterparts to report having had negative health care experiences over the last three years, according to a new report.

One-third (33%) of LGBTQ adults say they were treated unfairly or with disrespect or had at least one negative experience with a health care provider, compared to 15% of non-LGBTQ adults, according to a new report by KFF, a health care and polling nonprofit formerly known as the Kaiser Family Foundation. 

Of the LGBTQ adults who reported negative experiences, 61% said a provider assumed something about them without asking, suggested they were personally to blame for a health problem, ignored a direct request or question or refused to prescribe needed pain medication, compared to 31% of non-LGBTQ adults who reported negative experiences.

Those negative encounters have an effect on LGBTQ adults’ health, the survey found. Of LGBTQ adults who reported having negative health care experiences in the last three years, nearly one-quarter (24%) said those experiences caused their health to get worse, compared to 9% of non-LGBTQ adults; 39% said those experiences made them less likely to seek health care, compared to 15% of non-LGBTQ adults; and 36% said such negative experiences caused them to switch health care providers, compared to 16% of non-LGBTQ adults.   

Lindsey Dawson, director of LGBTQ health policy at KFF, said the report provides a helpful update on the experiences of LGBTQ people at a time when dozens of state bills have targeted their access to health care and protections from discrimination.

“The survey suggests a need for targeted and culturally appropriate policy solutions aimed at improving the well-being of the LGBTQ community broadly to promote health equity,” Dawson said. “This could include policymaking that addresses discrimination in social institutions, like health care, and challenges in accessing culturally competent mental health, as well as systemic drivers of stigma and discrimination.” 

KFF surveyed 6,292 U.S. adults online and by telephone from June 6 to Aug. 14, 2023. The margin of error for the full sample is plus or minus 2 percentage points. The margin of sampling error for LGBTQ adults specifically is plus or minus 7 percentage points. 

Certain groups of LGBTQ adults were more likely to report negative experiences in health care settings, the survey also found. More than one-third, or 41%, of LGBTQ adults with lower incomes, 35% of LGBTQ women and 37% of LGBTQ adults ages 18-29 said a doctor or other health care provider treated them unfairly or with disrespect in the past three years, compared to 22% of LGBTQ adults with higher incomes, 25% of LGBTQ men and 22% of LGBTQ adults over 50. 

Black and Hispanic LGBTQ adults were more likely than white LGBTQ adults to report unfair or disrespectful treatment by a health care provider because of their racial or ethnic background, the report found, though unfair treatment for other reasons — such as their gender, health insurance status or ability to afford care — “cuts across racial and ethnic groups among LGBT adults,” with 26% of Black LGBTQ adults, 23% of Hispanic LGBTQ adults and 32% of white LGBTQ adults reporting unfair or disrespectful treatment for other reasons.

Despite reporting higher rates of unfair treatment and discrimination in health care settings, LGBTQ adults reported having positive interactions with health care providers most of the time. According to the survey, 70% of LGBTQ adults said their doctor or provider did the following four actions at least “most of the time” during visits in the past three years: 81% said providers explained things in a way they could understand; 81% said providers understood and respected their cultural values and beliefs; 76% said providers involved them in decision making about their care; and 70% said providers spent enough time with them during their visit.

Alex Sheldon, executive director of GLMA, an association of LGBTQ health care professionals that advocates for more LGBTQ-inclusive research and medical training, said the survey findings underscore what we already know about LGBTQ health, particularly the “critical link between discrimination and health outcomes.” 

“We see that LGBTQ+ people report higher rates of anxiety, depression and loneliness compared to our non-LGBTQ plus peers, but we also know that these disparities aren’t innate, and they’re driven by the harmful ways in which we’re treated by the world around us,” Sheldon said. 

Sheldon added that, as long as LGBTQ people fear discrimination in health care settings and feel they have to mask parts of their identity, then they can’t get the care they need.

“If we can’t tell the truth about who our partners are, about the nature of our work, about who our families are, then we can’t expect health professionals to be able to accurately address any health issues that arise,” Sheldon said. “They don’t have the full picture and they’re not willing to look for it. Until we’re met with dignity and we’re met with respect and acknowledging our full selves, we’re not going to be able to actually get the full range of health care that we need.”

The data in the KFF report, the authors wrote, shows where additional nondiscrimination protections, provider training and addressing mental health stigma, among other solutions, are needed. Twenty-nine states have laws that prohibit discrimination based on gender identity and/or sexual orientation in public accommodations, including doctors’ offices. Ten states have religious exemption laws that allow medical professionals to decline to serve LGBTQ clients.