Discrimination in Healthcare: A Field Experiment with Pakistan’s Transgender Community

Abstract

Transgender individuals face high levels of discrimination including in healthcare. Lack of adequate legal protections can exacerbate the problem in developing countries. At the same time, low-cost private clinics can mitigate discriminatory practices due to the costs of discrimination. We conduct an audit study with male and transgender standardized patients visiting private health care clinics in Pakistan and find evidence of discrimination in non-obvious domains. Physicians differentiate between patients in culturally sensitive areas: they substitute in procedures that require less physical contact; are less likely to engage in verbal examination (i.e. avoid uncomfortable questions); and are subsequently more likely to recommend placebo or insufficient treatments for transgender patients, relative to the male benchmark. This ultimately yields lower quality of care for transgender patients.