1. Health Care Access and Perceptions of Provider Care among Individuals in Same-Sex Couples Joseph Clift AHRQ/Environmental Protection Agency James Kirby AHRQ

2. Background Most research on LGBT people focuses on health disparities, not access, use or perceptions Most research on LGBT people focuses on health disparities, not access, use or perceptions Most research is based on small, convenience samples Most research is based on small, convenience samples

3. Objective Compare individuals in same-sex couples to those in different-sex married couples Compare individuals in same-sex couples to those in different-sex married couples – Access – Preventive Use – Perceptions of care

4. Method Descriptive statistics with difference tests corrected for the complex sample design Descriptive statistics with difference tests corrected for the complex sample design Logistic regression models controlling for a limited number of basic sociodemographic variables Logistic regression models controlling for a limited number of basic sociodemographic variables – Age, household income, highest degree, metropolitan residence and insurance status

5. Data Medical Expenditure Panel Survey, pooled for 1996-2007 Medical Expenditure Panel Survey, pooled for 1996-2007 Sample: individuals who are married or who report having a “partner” of the same sex Sample: individuals who are married or who report having a “partner” of the same sex – 136,676 married individuals – 696 individuals in same sex couples

6. Variables Access Access Preventive Use Preventive Use Perceptions of Provider Care Perceptions of Provider Care

7. Results: Access * *

8. *

9. Results: Preventive Use *

10. Results: Perceptions of Provider Care *

11. Odds-ratios from Logistic regression model Variable Different- sex Same- sex Got medical appointment when wanted (urgent)1.00.8 Got medical appointment when wanted (non-urgent)1.00.6 Easy to see a specialist1.00.6 Delayed in getting necessary prescription drugs1.02.4 Had flu shot in last year1.01.7 Doctor showed respect1.00.6 Doctor spent enough time1.00.7 * * * * * *

12. Summary and Conclusions Statistically significant differences exist on: Statistically significant differences exist on: – Timeliness of getting appointments and Rx drugs – Ease in seeing specialists – Annual flu shot Most measures show no statistically significant difference Most measures show no statistically significant difference Overall pattern of differences indicate that individuals in same-sex couples have generally worse access and more negative perceptions of care Overall pattern of differences indicate that individuals in same-sex couples have generally worse access and more negative perceptions of care – Annual flu shot is the exception

13. Limitations Cannot infer to LGBT people, only to those in same-sex cohabiting couples Cannot infer to LGBT people, only to those in same-sex cohabiting couples Differences are “averages” over 12 years Differences are “averages” over 12 years Descriptive Descriptive