Health Care Bias, Cost of Care Biggest Barriers to Liver Care for LGBTQI+ Patients

Health care bias can have profound and lasting impacts on marginalized communities, especially within the LGBTQI+ population. Sarah Manes, liver cancers program director of the Global Liver Institute (GLI), delves into the critical issue of how bias—whether conscious or unconscious—between providers and patients can inhibit trust, hinder communication, and ultimately compromise care.

In this interview, Manes explores the unique challenges faced by LGBTQI+ individuals, particularly those with disabilities, in accessing and receiving appropriate liver care. She sheds light on how financial barriers and a lack of competent, empathetic health care can lead to devastating gaps in treatment, raising urgent questions about equity and inclusion in the health care system.

This transcript has been lightly edited for clarity.

Transcript

What are some common barriers LGBTQI+ patients face when seeking care for liver-related issues?

One of the most common things we see truly comes down to the health care bias. You know, what does it look like if providers have a bias towards marginalized populations, and how does that end up affecting the patient and the provider relationship? If there is bias that's coming from a patient who's not comfortable answering the questions, and equally, if the provider isn't comfortable asking the right questions, what does that do to the LGBTQI+ population and really instilling trust and open conversation?

Also, looking into disability bias, some research has found that LGBTQI+ patients experience a higher rate of reported disabilities than their heterosexual counterparts. Why is that? Is it that bias that's coming from a provider that is maybe asking questions in a different way that they're not doing to their heterosexual patients? How do we continue to explore that?

I also think talking about the cost-of-care barriers, oftentimes with transgendered people, in one of the studies that we looked at, 42% of them who are disabled and 30% of nondisabled said, due to financial barriers, within that 1-year period of time, they didn't seek any health care expertise or follow-up. So when we look at liver-related issues and having ongoing care, what happens when you're not going for that year of follow-up or even to get the liver disease diagnosis in the first place? If you don't have that competent and trusting care, what ends up happening through that treatment and kind of ongoing space of an [health care provider] relationship?