LGBTQ Health Policy Analysis
LGBTQ Health Policy Analysis
The term LGBT is an initialization for lesbian, gay, bisexual, and transgender community that indicates diversity in sexuality. However, non-heterosexual individuals who are uncertain of their sexual orientation are said to be queer and questioning; hence, the letter Q in this notion appears.
Therefore, LGBTQ stands for lesbian, gay, bisexual, queer questioning, and transgender persons. A health policy, on the other hand, is the set of laws, plans, decisions, and administrative actions that are implemented in order to actualize certain healthcare aspirations within the society. Though some people continue discriminating the LGBT group, implementing policies that would protect the latter is crucial because they will be able to access health services like other ordinary individuals.
A well-planned and executed policy can achieve numerous milestones. It envisages the future aspirations of healthcare achievements that are then used to target and reference points for both medium and short terms. A health policy prioritizes particular issues and the roles different groups will play to tackle those aspects as well as reaches consensus by making people more informed. Healthcare policies are meant to achieve nation’s overall health objectives by affecting different levels of the healthcare ecosystem.
The policies can be considered at the clinical practice, healthcare system or social and public levels. Considering the two latter, the policies are created with the purpose of evaluating the health status of the LGBTQ population and the threats it faces. The policies of the healthcare system stage affect the institutions and the resources that provide services to meet LGBTQ group’s health needs. The clinical practice policies guide a practitioner on how to optimize care in the LGBTQ patient’s best interest, making them, at the same time accountable for their clinical activities. (Romanelli & Hudson, 2002) The LGBTQ population has been sidelined and marginalized with respect to obtaining equity in services and affordable healthcare for their families. It is crucial to analyze the health policies in terms of medical care systems and clinical practice in America. It will assist in dealing with discrimination this population faces when it comes to purchasing medical insurance, acquiring medical covers by their employers, and reaching quality medical service as well as and other issues that hinder the actualization of equitable and affordable healthcare for all.
The society has been politically mobilized leading to the right to healthcare being considered universal. However, many societies and countries across the world still violate this fundamental human right by excluding and discriminating against the LGBTQ. The latter usually experience prejudice when seeking medical services. For this reason, this population has been reluctant to seek medical services despite being susceptible to various health problems including alcohol and drug abuse, obesity, a mental disorder resulting from stigma, physiological conditions because of bullying, sexually transmitted diseases, breast and cervical cancer, and the outcomes of violent behavior. This sexual minority group has also faced significant social stigmatization.
Some healthcare practitioners have homophobic mindsets that affect the nature of service they give to the sexual minorities. In extreme cases, they consider LGBTQ to be unworthy of formalizing marriage and adopting children, thereby repulsing members of this group (NCBI, 2016). The misconducts of such professionals, their prejudice connotations, and verbal abuse have contributed to the low rates of seeking medical assistance by this class of people. The access to proper and affordable healthcare for the sexual minorities is also hampered by the difficulty of acquiring medical insurance covers. Such social groups, therefore, cannot afford regular screening and checkups that they particularly need as they are classified as having pre-existing conditions by the insurance companies that make them, thus, ineligible for coverage. The required treatment is often delayed until it becomes impossible to cure or manage it.
Brazil is one of the countries that managed to enforce health policies that look into the specific needs of the LGBTQ community. The country enacted the National Comprehensive LGBT health plan in 2010 (NCBI, 2016). The policy sought to protect LGBT population against violence while promoting adoption and legalization of same-sex marriages. It covers healthcare and juridical systems by taking legal actions on any person or institution found to be discriminating others based on their sexual orientation including clinical practitioners.
Brazil made major milestones by implementing this policy. One of the notable strengths was that it addressed administrative homophobia and prejudice issues towards the sexual minorities by accepting legal measures against healthcare professionals and medical facilities discriminating such people. Another strong point is that it manages to provide easy access to health facilities and services to this group. However, the most notable shortfall of this policy lies in the fact that it lacked the comprehensive social aspect of the sexual minorities’ health. Since its enactment, the cases of bullying, homophobia and depression increased significantly, especially among adolescent teenagers. It means that it did not have a plan for educating the society and de-radicalizing the Brazilians against their homophobic perceptions.
In this section, the paper considers two health policies formulated by different bodies in the USA. The first one is the Affordable Care Act that was implemented by the government to help bridge the gap in healthcare access, especially for the low-income individuals and the LGBTQ community. It aims at achieving healthcare equity by enforcing the system-based policies that target insurance companies, healthcare service providers, and medical training institutions. The other policy is the American Medical Association policy on LGBTQ healthcare. These acts have been formulated by the medical profession body that is focused mainly on clinical practitioners in terms of their training environment in preparation to effectively meet the healthcare needs of the sexual minority groups.
The Affordable Care Act (ACA) Health Policy
The Affordable Care Act (ACA) is the American government’s initiative that aims at bridging the gap of access to healthcare services and facilities for the LGBTQ and the heterosexuals. The act provides easy access to health insurance and protects the sexual minorities from discriminatory clauses. The ACA also enforced a civil rights law that protected the sexual minorities against discriminations in health activities and programs. This section affects the hospitals and the medical practitioners (Molinari, 2014). ACA has also established mechanisms for facilitating LGBTQ cultural competent training institutions in the marketplace that will promote the integration of the relevant content into educational resources. It will affect the healthcare training institutions, in overall
The ACA is remarkable in the following perspectives: it managed to slow the rate at which healthcare costs rose by providing free preventive care; it made it mandatory for insurance companies to cover for most of the conditions affecting the LGBTQ such as mental disorders, addiction, and chronic diseases; and it prohibits the same firms from denying coverage on pre-existing conditions at the marketplace and state insurance exchanges (Molinari, 2014). Besides, the policy has eliminated annual coverage limits for its beneficiaries and has ensured free non-discriminatory access to healthcare by implementing the above issues.
American Medical Association (AMA) Policies on LGBTQ
AMA policies focus on gender identity and sexual orientation struggling against abuse and discrimination of LGBTQ communities. They work to inform the clinic practitioner on the best approach in providing equal services to all. The AMA policies are divided into three major categories, namely the general policies section, physician-centered policies, and patient-centered policies.
The first type advocates for the continued support of freedom of expression and general human rights with respect to sexual context. The AMA has a nondiscriminatory policy where its members are required to provide medical services to their patients without profiling them based on their sexual orientation or identity (American Medical Association, 2017). Physician-center acts for AMA condemn discrimination and establish an ethical council to deal with such judicial issues. The policies call for the diversity in workforce, especially in the healthcare, to involve more sexual minorities to help reduce prejudice towards them. The AMA recommends eliminating medical disparities by developing the LGBTQ health issues awareness and education that will be included in the medical training. It will help to develop a competent medical staff to handle potential patients appropriately.
The AMA also has patient-centered policies that highlight the unique health needs of the sexual minorities and identify the disparities in health care access, especially in the same-sex partner household. The policy aims at undoing the “don’t ask, don’t tell” narrative that promotes aggression towards the sexual minority groups (American Medical Association, 2017). The acts focus on tackling aggression and stigmatization based on sexual identity in schools. AMA calls for the removal of financial barriers to affording healthcare for the LGBTQ. It also implies continuous research of LGBTQ healthcare aspects and emerging related topics to evaluate the success of these policies at the national leve.
Evaluation and Trade-offs
The criteria the paper uses in evaluating the above policies are based on three questions: Which policy addresses the clinical practice issues relating to sexual minority groups healthcare in the most profound way? Which policy deals with treatment issues of this population to the full extent? Which policy is the most feasible when implemented at relevant points? The ACA is focused on achieving easy and affordable access to medical services by providing insurance, cover, and legal protection for the sexual minorities. Thus, it adequately addresses the treatment aspect of their healthcare challenges. On the flip side, it places little attention to the caregivers and how they handle their patients. Hence, it does not consider the aspect of prejudice effectively in its policies.
The AMA, on the other hand, places stress on the societal and clinical aspects of the LGBTQ health care. It stresses the importance of dealing with stigmatization in the community, schools, medical training institutions, and workplaces to promote healthcare in this group. It emphasizes the need to present equal opportunities and sensitization of clinical practitioners to this group of population to encourage them to seek healthcare. It also highlights the need to abandon the discriminatory insurance clause, thus facilitating accessing health services.
Both these policies are feasible at their level of implementation, thereby making it difficult to decide which one between the two is more profound. Neither of these policies is superior to the other. Therefore, as a trade-off, a combination of these two acts will lead to a holistic success in achieving quality and non-discriminatory healthcare services for the LGBTQ community.
LGBTQ health issues are three-dimensional; particularly, they include the clinical practice, the health system, and the social aspects. From the analysis above, it is evident that each of policies discussed effectively addresses specific aspects of the LGBTQ health and merely considers the other. Therefore, the rational thing in selecting the better policy is to apply a combination of the two acts to produce an all-inclusive policy. It will be the most appropriate option as it will tackle all three dimensions of the LGBTQ health.
The recommended strategy in implementing the above alternative is the management by the objective strategy (MBO) that defines the goals that need to be achieved in advance so that the stakeholders, in this case, the health system and providers, the clinical practitioners, and the society, understand what they need to do to attain those aims. This strategy will bring a feeling of inclusivity among all the sectors and affected parties leading to minimal resistance that usually results from imposing policies.
The major barrier of enforcing this alternative is the resistance from the society. The MBO is a self-managing strategy with little involvement of the regulators, namely the department of health. The PR actioners, providers, institutions, and the society need to set personalized goals towards the full implementation of the policy. The adoption of this strategy will fail if the society or any of the three players are resistant to change or feel reluctant to set their goals.
Policy implementation will be evaluated at two levels: self-evaluation by the individual players and periodic review to assess the progress on the overall policy employment. It will be processed by assessing to what extent the set goals have been attained in both cases, initiating a corrective action if necessary.
There is a need to consider the two selected health policies and regard how they can be integrated into the advanced nursing practice knowledge. The effects of implementing these policies will be elaborated at the clinical practice level, healthcare systems, and their social effects. The AMA provides the detailed guidelines of how clinical practitioners need to act professionally with respect to these patients (American Medical Association, 2017). Enforcing such policies will help to build a culture of tolerance and acceptance in the nursing fraternity as it advocates for equity and upholding of human rights for all.
The AMA promotes an all-inclusive community at the colleges as applicants should not be denied the admission to these learning institutions. Providing equitable accommodation for all will enable the students to integrate into the community and form friendships that will assist in resisting the prejudice as they enter the job market. Creating the learning content that highlights the unique healthcare needs of the LGBTQ population will help the nurses understand the health issues and threats these patients face, hut helping make proper decisions when the latter visit a hospital for a checkup. Having a body that monitors the ethics of clinical practitioners with a specific interest in complaints filed by sexual minorities will push the healthcare professionals to act relevantly.
AMA focuses on establishing a structure that will assist in eradicating bullying in schools and other institutions. It also advocates for inclusivity of these sexual minorities at the workplace and providing them with equal opportunities. ACA, on the other hand, puts in place a legal framework for prosecuting people who discriminate against others based on their sexuality and sexual orientation. It will help address the social health issues such as depression and mental disorders resulting from stigmatization.
The ACA policies target the medical insurance companies with their discriminatory clauses and exclusions, which previously made it difficult for minority groups to afford quality healthcare. It also considers medical service providers and institutions that tend to show discriminatory practices (Molinari, 2014). This measure compels the insurance companies to provide affordable coverage to LGBTQ high-risk ailments that are usually under the exclusion clause. Such actions will ensure that this population accesses timely healthcare service and regular checkups, thus significantly reducing ER cases.
It was, however, challenging to process the proper analysis and comparison of numerous health policies with respect to LGBTQ healthcare due to the limited research being done regarding this topic. Few countries have managed to integrate the health needs of this population in their national health master-plan. It is, therefore, recommended that continuous studies and evaluations of these policies be conducted to achieve the more robust inclusivity of the healthcare needs of this social group without compromising the overall system.
The access to affordable healthcare is a universal right that must be adhered to in any case. There have been several barriers that impede actualization of this fundamental right to lesbians, gay, bisexual, queer, and transgender groups. These issues have to be addressed by involving the players of the health sector, the practitioners, and the society at large. There is a need to establish systems that will coordinate the sensitization of the human rights and freedoms of the sexual minorities and conduct educational programs to eradicate homophobia. Every player needs to set goals and continuously evaluate the achievement of progress toward the full implementation of the combined ACA and AMA policies for LGBTQ. When all the impending factors would have been covered sufficiently, it will be considered that the country has enforced a comprehensive healthcare policy for the LGBTQ community.
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