Access to health care during COVID-19: BIPOC and LGBTQ affected the worst in King County

 

By Sahla Suman 

Introduction 

The COVID-19 pandemic is dramatically impacting people's lives. Along with millions of cases and over half a million deaths, it has caused drastic changes to people’s social lives, financial stability, and overall health. But, for some people, the pandemic's toll is heavier than others, especially communities that are suffering from structural racism and discrimination. Nationally, the death rate due to COVID-19 is two times greater among Blacks than whites. The LGBTQ community is experiencing a higher rate of job loss and challenges to acquire health care services compared to others during the pandemic. During the pandemic, COVID-19 related needs and demands for health care services increased; however, there was a decline in the utilization of non-COVID-related medical care. There are myriads of reasons behind this, including unequal access to health care. Even before the beginning of the pandemic, inequities in health care access based on race/ethnicity, gender, and sexual orientation were a major public health concern. Often, communities marginalized by both racial/ethnic and sexual or gender identities experienced even worse inequities. The Washington State Department of Health conducted the Community Oriented Recovery Needs Assessment (CORONA) survey to assess the pandemic’s social, economic, and overall health impacts on people’s lives. The new data from this survey throws some light on the effects of the COVID-19 pandemic on inequities in access to health care issues in King County.  

In this survey, people were asked whether they could not see a doctor due to cost (before and after the onset of the pandemic) or due to COVID. People were also asked whether they had experienced any difficulty getting medication during the pandemic. Figure 1 shows the response to the question about the experience of access to health issues due to cost before the onset of the pandemic. 

Figure 1. Washington state CORONA survey: result on access to care issues due to cost BEFORE the pandemic in King County

Fig 1 (1).png

16% of King County residents responded that they could not see a doctor due to cost before the pandemic. (Figure 1). But, overall, only 13% of people reported that they could not see a doctor because of cost after the onset of the pandemic (Figure 2). The survey did not ask about the specific reasons behind this. But it is possible that the people met barriers other than cost to access medical care during the pandemic, such as COVID-related non-financial barriers. For example, 41% of the respondents said they did not see a doctor because of the COVID-19 pandemic.

Figure 2. Washington state CORONA survey: result on access to care issues due to cost AFTER the onset of the pandemic in King County

Fig 2 (1).png

Looking at the data by sexual orientation, those who identified as queer were more likely not to see a doctor due to cost both before and after the onset of the pandemic, while this percentage was lowest among people who identified as straight (Figures 1 & 2). Across different race/ethnicity groups, access to health care varies. Before the pandemic, Black, Indigenous, and People of Color (BIPOC) residents in King County were more likely to not visit a doctor due to cost compared to people who identified as white. Even after the onset of the pandemic, BIPOC residents had the highest rates of not visiting a doctor due to cost by race/ethnicity. Among the BIPOC community, American Indian/Alaska Natives (29%) and Hispanics (30%) were more likely unable to seek medical care due to cost issues (Figure 2).

Figure 3. Washington state CORONA survey: result on access to medication issues AFTER the onset of the pandemic in King County

Fig 3 (1).png

Access to medication: 1 in 10 respondents could not get medicine because of the COVID-19 pandemic (Figure 3). Access to medication differs across different genders and sexual orientation. People who identified as 'another gender' were twice as likely to be unable to get medicine when needed than those who identified as male or female (Figure 3). American Indian/Alaska Native and Hispanic respondents were twice as likely to be unable to get medication because of the COVID-19 pandemic than whites.

Figure 4. Access to health care due to cost BEFORE COVID-19 based on race/ethnicity and sexual orientation

Fig_4[1].jpg

Figure 5. Access to health care due to cost AFTER the onset of COVID-19 based on race/ethnicity and sexual orientation

Fig 5 (1).png

The intersectionality of race/ethnicity and sexual orientation and its influence on access to care during the pandemic:  

This survey was not a representative sample of the King County population. Additionally, the number of responses obtained in some categories were too small to analyze. Hence, to make a more meaningful interpretation about the influence of intersectionality of race/ethnicity and sexual orientation on the impacts of COVID-19, we had to aggregate groups of people who identified as gay, lesbian, bisexual, and queer into LGBQ. Overall, among total respondents, the percentage of people with unmet needs for health care and medication was two times higher among those identified as LGBQ than the respondents who identified as straight before and during the COVID-19 pandemic. These inequities in access to health care are often compounded with intersection of race/ethnicity and sexual orientation (Figure 4 and 5).  

Access to health care among people who identified as BIPOC and LGBQ was disproportionately high. Within the respondents who identified as LGBQ, some BIPOC groups were more likely to be unable to see a doctor and get medications than the respondents who identified as LGBQ and white. For example, before and after the pandemic's onset, difficulty visiting a doctor (36%) and getting medicine (28%) was highest among Hispanic LGBQ respondents (Figures 5 & 6). 1 in 4 Black LGBQ respondents could not get medication when needed during the COVID-19 pandemic (Figure 6). Here also, we see a decline in the overall percentage of people who reported difficulty with health care access during the pandemic. We don’t think cost was the barrier; this decline is most likely due to the emergence of many non-financial barriers during the COVID-19 pandemic, such as limited availability of health care services, lack of culturally competent health care services, and fear of exposure to the virus.

Figure 6. Access to medication issues during COVID-19 based on race/ethnicity and sexual orientation

Fig 6 (1).png

Conclusion and limitations: The CORONA survey reveals that the COVID-19 pandemic increased barriers to accessing health care in King County. The pandemic has exacerbated the inequities in access to care and medication among different racial/ethnic groups and people who identified as LGBQ. BIPOC residents have been most affected by access to care issues before and during the COVID-19 pandemic. The intersection of race/ethnicity and sexual orientation has a compounded effect on inequities in health care access during the pandemic in King County. Any further delay in tackling these inequities during the pandemic will impact and elevate the health disparities that BIPOC and LGBTQ communities are already experiencing. To reduce the toll of COVID-19 on BIPOC an LGBTQ communities and build a healthier and more resilient region, we must stop the spread of not only the COVID-19 virus but also the inequities, structural racism and discrimination.

About the data: Nearly 9,200 King County residents responded to the CORONA survey online and via phone. The questionnaire was available in different languages, including English, Spanish, Vietnamese, Russian, Tagalog, and Somali. Out of the total 27 questions, respondents were asked four questions regarding their access to medication and health care services. The overall results are displayed on the dashboard. They can be seen by demographics such as race/ethnicity, age, gender, sexual orientation, household income, education, and employment sector. An initial blog post of the overall results was published at the beginning of this year. This second blog post focuses on the CORONA survey results around health care access issues in King County during the pandemic, emphasizing inequities in health care access based on race/ethnicity and sexual orientation.  

As mentioned before, the CORONA survey was not a representative sampling of King County, so the data only tell us about the experiences of people who chose to respond. Overall, 71% of the survey respondents were white, and 75% of respondents identified as females. BIPOC respondents, were underrepresented in this survey. Therefore, the survey population does not represent the actual population of King County. The demographic comparison of the CORONA survey respondents and the actual King County adult population is available on the dashboard. 

If you are LGBTQ+ and/or BIPOC and are experiencing difficulty with access to care and medication, here are a few resources you can go to for help: 

 
Guest User