Discrimination in healthcare: A field experiment with Pakistan's transgender community

Abstract

Transgender individuals face high levels of discrimination and bias. However, it is not clear how such biases result in different levels of care. Using an in-person audit-study, we randomize cisgender male and transgender standardized patient visits to low-cost private clinics in Pakistan. We detail out the entire process of obtaining healthcare. Results show that transgender patients are treated differently, but consistent with preservation of dignity. Physicians substitute in procedures that require less physical contact; are less likely to ask culturally sensitive questions; and are more likely to recommend different treatment plans. These practices yield lower quality of care, though they do not stem from overtly discriminatory practices. It is important to note two caveats. We work with a small sample and therefore our results are not always precise enough to be informative. Further, without cisgender female patients, our results are not always informative about discriminatory practices against transgender patients.