Association for Public Policy Analysis & Management

Background and Significance: This research examines sexual orientation and gender disparities in health insurance coverage and health service utilization among a population-based sample of working-age individuals. Prior research on sexual orientation disparities in health outcomes suggests that bisexual individuals report poorer health and greater activity limitation than heterosexual individuals. Moreover, bisexual individuals are more commonly reported to lack health insurance coverage and a regular health care provider than heterosexual individuals. While differences in health outcomes, health insurance coverage, and health service use by sexual orientation are thus readily apparent, few studies consider the degree to which health insurance coverage moderates the impact of sexual orientation on health service use. Theoretically, this study relies on prior racial and ethnic health care disparities research to define the term “disparities” as those differences in health insurance access and health service use except those due to clinical need. Defining disparities as such, this research first reexamines the extent of sexual orientation differences in health insurance coverage and health service use, and then investigates whether and to what degree health insurance coverage moderates the impact of sexual orientation on health service use.

Methodology: Data were drawn from the 2013-14 waves of the MA-Behavioral Risk Factor Surveillance System to yield a final study sample of 15,519 individuals ages 18 to 64. Logistic regression analyses were conducted to specifically examine: 1) the extent of sexual orientation differences in both private and public health insurance coverage, 2) the extent of sexual orientation differences in annual routine checkups and financial barriers to health care access, and 3) the degree to which private and public health insurance coverage moderates the impact of sexual orientation on health service use.

Results: Bisexual women were 40% less likely to have an annual routine checkup while gay men were 1.38 times more likely to have an annual routine checkup relative to their heterosexual same-sex counterparts. Bisexual women were also 1.53 times more likely to report a financial barrier to doctor or medicine access relative to heterosexual women. After interacting sexual orientation and health insurance status, lesbian and gay individuals with public insurance coverage were 2.82 times more likely to report a financial barrier to health care access and yet 1.88 times more likely to have an annual routine checkup relative to heterosexual individuals with other or no insurance. Meanwhile, bisexual individuals with public insurance coverage were 2.77 times more likely to report a financial barrier to health care access but not more likely to have an annual routine checkup relative to heterosexual individuals with other or no insurance.

Discussion and Conclusions: A significant segment of LGB individuals appear to be negatively impacted by health inequalities and bisexual individuals, in particular. Since LGB individuals are more likely to interface with health professionals due to behavioral health issues, HIV, sexual violence, and other health needs, the findings from this study provide evidence regarding the potential mitigating impact of health insurance coverage among self-identified bisexual, gay, and lesbian populations.