A transgender man’s medical providers repeatedly used his birth name, even though he changed it during his transition.
A doctor insulted a Latina woman while she was receiving mental health care, telling her she “needs to change her beliefs now” that she’s living in America.
In parts of rural Colorado, there are so few health care providers, and so much turnover, people of color and LGBTQ people struggle to find providers from a similar background who can understand their needs.
Those are just a few of the findings of a new report that highlights gaps in Colorado’s health care system and examines access to “culturally responsive care,” or treatment that provides an inclusive atmosphere where patients’ cultural beliefs and identity are respected and considered.
“Our new report shows us just how much work we have to do across the entire health system to continue expanding access to care that respects and takes into account peoples’ needs related to language access, sexual orientation, culture, disability and experience with trauma,” said Caitlin Westerson, director of state external affairs and partnerships for United States of Care, the national organization that compiled the report and released it Thursday.
The need for culturally responsive care is increasingly important because it humanizes the health care experience and shows patients their providers care about them as a whole person, said Lowell Hamilton, research and community engagement manager, at United States of Care.
☀️ READ MORE
Nearly 400,000 Coloradans said they were looking for culturally responsive care to respond to their language, sexual orientation, culture, disability or trauma needs, according to a 2021 report by the Colorado Health Institute.
Several Colorado organizations on Tuesday said they were working to increase access to care for LGBTQ Coloradans, people in rural areas of the state and people of color.
Colorado health care leaders and insurers have made efforts to create a more culturally responsive health care system but more work is needed, according to United States of Care, a nonpartisan organization working to make health care more equitable in the wake of the COVID-19 pandemic.
United States of Care conducted interviews from April to September with Coloradans with disabilities, patients who speak English as a second language, people of color and patients who are part of the LGBTQ community.
Those individuals said they have low expectations of the health care system, they feel disrespected when receiving care and they don’t want their gender to continue impeding their access to receiving quality care, according to the report.
Implicit bias among health care providers and insurers, who have little understanding about unique health care needs such as gender-affirming care for transgender people, are negatively affecting Coloradans’ while they seek care, according to the report.
There’s little diversity in Colorado’s health care workforce and providers who are able to practice in underserved and diverse communities face administrative burdens, high cost of living, low compensation and high turnover, according to the report, which also summarizes interviews with leaders at advocacy, government health care and academic organizations.
The “fragmented” health care system is leading to rushed appointments that make patients feel undervalued, confused, overburdened and dismissed, the report says.
Coloradans reported many other frustrations with their health care options and said too much emphasis is placed on providing prescription drugs as a remedy to their health care needs.
Implicit biases held by providers means some patients lose interest in seeking care at all, so they forego needed treatment.
Some patients said they have had to find new providers when they felt disrespected or judged because of their identity, according to the report.
The reported issues are compounded by staffing shortages, which are reaching crisis levels, according to the report. There’s a rapidly declining number of nurses and primary care providers in rural areas. There will be a shortage of up to 86,000 physicians nationwide by 2036, according to a report compiled by a data analytics consulting firm this year for the Association of American Medical Colleges.
“This sends a large ripple effect throughout the economy but also sets a tone of distrust,” said Liz Hagan, director of policy solutions, at United States of Care.
The 2021 Colorado Health Access Survey showed 25% of Coloradans who sought culturally responsive care were unable to receive it.
The number of Coloradans who experienced disrespectful treatment while receiving medical care nearly doubled since 2021, according to the health access survey released in 2023.
That survey also showed that 12% of Coloradans said their language, race, religion, culture, gender, sexual orientation or disability is a major factor that determines the kind of health care they need.
United States of Care supports the 2021 Colorado Option, the first health care plans designed to improve health equity.
The Colorado Option, which has about 80,000 Colorado members, established culturally responsive health care provider networks that require plans to create provider networks that reflect the diversity of the people they serve.
One part of the Colorado Option that should be implemented by other insurers is the requirement that providers receive anti-bias and culturally responsive training, the report’s authors said.
The report includes a long list of policy recommendations the organization hopes lawmakers, insurers and health care providers will implement in Colorado and across the country.
— Insurers, providers and state leaders should develop programs to recruit and retain a more diverse workforce, the report says.
— The state legislature should increase funding for developing and maintaining culturally competent care training programs.
— Insurers should improve provider directories at non-Colorado Option insurance plans by including information about available translation or interpretation services.
It also said the state should find ways to improve and expand internet access and digital literacy in rural communities so that patients can access telehealth and critical information about their health care.
One Colorado, a Denver-based nonprofit working to advance equality for lesbian, gay, bisexual and transgender people across the state, is partnering with two other organizations to offer training to physicians to increase the number of providers who are equipped to care for the community, said Alex Floyd, health equity director at One Colorado.
In the training, physicians are taught general knowledge such as what the LGBTQIA+ acronym stands for, how to gently ask patients what their pronouns are, how to make intake forms and photos in office spaces welcoming and inclusive and about the biggest gaps in care that most affect people in the LGBTQ community, Floyd said.
One Colorado conducted a statewide study in 2018 and found 48% of LGBTQ Coloradans surveyed said they didn’t know if their provider was open to treating lesbian, gay, bisexual or transgender patients or that their provider was not open to it at all.
In 2021, the Denver-based nonprofit Envision:You led a similar survey and found people are struggling to find providers who understand the unique needs of LGBTQ patients and how to provide appropriate care.
“If we are going to providers who don’t understand our needs, that means we might be experiencing microaggressions, bigotry, transphobia and homophobia when we’re trying to seek health care,” Floyd said. “There’s the unintentional missing of our needs to the ill-intended refusal of treatment, or poor treatment, because the physician doesn’t understand me or agree with my lifestyle.”
Health care inequities persist because of systemic issues still faced by people of color, people with disabilities, LGBTQ Coloradans and others in rural parts of the state, Floyd said.
“It’s going to be an uphill battle for a while,” Floyd added. “There are a lot of attitudes that need to shift and a lot of knowledge people need to gain, in addition to policy changes, to start to see these shifts happen.”