• gay-friendly providers in the plan, making a concerted effort to recruit lesbian- and gay-friendly providers, and instituting cultural competency training programs to enhance the ability of their providers to serve lesbians.
  • The general lack of availability of family or household health insurance coverage for members of lesbian households makes it especially difficult for these individuals to see the same providers and enjoy family-focused care and the multiple benefits this can provide. Although domestic partner benefits are now increasingly available through some employers, most lesbians still do not have the option of coverage under their partner's health insurance plan. If two partners are covered under different managed care plans they will have access to the same provider only if that provider is part of both plans. Additional information is needed to determine whether managed care has a differential impact on lesbian health care, and how managed care organizations can best accommodate the health care needs of lesbians.

Lack of Legal Recognition of Partners. Hospitals and health care providers do not always give the partner of a lesbian patient, or the co-parent of a lesbian's child, the same rights to visit and to access information as is provided to a heterosexual spouse. There is also, in some cases, a legal refusal to honor the lesbian partner of a patient as her health care proxy even when so designated by the patient. In the MLHS, 9% of the respondents reported that health care workers had not allowed their female partners to stay with them during treatment or see them in a treatment facility; 9% also said that providers had not included their partner in discussion about the respondent's treatment (Bybee and Roeder, 1990).

Financial Barriers to Health Care for Lesbians

Since insurance coverage is the primary gateway to health care in this country, lesbians are at a distinct disadvantage relative to married heterosexual women because of the common prohibition against spousal benefits for unmarried partners (Denenberg, 1995; Stevens, 1995). Among respondents to the NLHCS, 16% stated that they did not receive health



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