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      Health Service Access Among Homeless Veterans: Health Access Challenges Faced by Homeless African American Veterans

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          Abstract

          Veteran homelessness is a public health crisis, especially among the disproportionate number of minority veterans in the homeless veteran population. African American homeless veterans in particular face unique challenges accessing appropriate health care services to meet their medical needs. Their needs are often underrepresented in the literature on veteran homelessness. Drawing together over 80 studies and government reports from the last two decades, this review provides a timely synopsis of homeless veterans’ health care access, with a particular focus on the barriers faced by African American veterans. This review employs Penchansky and Thomas’ Access Model to frame health access barriers faced by homeless veterans, dialing in on what is known about the experience of African American veterans, within the five dimensions of access: Availability, Accessibility, Accommodation, Affordability, and Acceptability. Actionable guidance and targeted interventions to address health access barriers for all veterans are delineated with a focus on the need to gather further data for African American homeless veterans and to consider tailoring interventions for this important and underserved group.

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          Patient-centred access to health care: conceptualising access at the interface of health systems and populations

          Jean-Frédéric Lévesque, Mark Harris, Grant Russell (2013)
          Background Access is central to the performance of health care systems around the world. However, access to health care remains a complex notion as exemplified in the variety of interpretations of the concept across authors. The aim of this paper is to suggest a conceptualisation of access to health care describing broad dimensions and determinants that integrate demand and supply-side-factors and enabling the operationalisation of access to health care all along the process of obtaining care and benefiting from the services. Methods A synthesis of the published literature on the conceptualisation of access has been performed. The most cited frameworks served as a basis to develop a revised conceptual framework. Results Here, we view access as the opportunity to identify healthcare needs, to seek healthcare services, to reach, to obtain or use health care services, and to actually have a need for services fulfilled. We conceptualise five dimensions of accessibility: 1) Approachability; 2) Acceptability; 3) Availability and accommodation; 4) Affordability; 5) Appropriateness. In this framework, five corresponding abilities of populations interact with the dimensions of accessibility to generate access. Five corollary dimensions of abilities include: 1) Ability to perceive; 2) Ability to seek; 3) Ability to reach; 4) Ability to pay; and 5) Ability to engage. Conclusions This paper explains the comprehensiveness and dynamic nature of this conceptualisation of access to care and identifies relevant determinants that can have an impact on access from a multilevel perspective where factors related to health systems, institutions, organisations and providers are considered with factors at the individual, household, community, and population levels.
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            Traveling towards disease: transportation barriers to health care access.

            Samina Syed, Ben S Gerber, Lisa K Sharp (2013)
            Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.
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              The concept of access: definition and relationship to consumer satisfaction.

              R Penchansky, J. Thomas (1981)
              Access is an important concept in health policy and health services research, yet it is one which has not been defined or employed precisely. To some authors "access" refers to entry into or use of the health care system, while to others it characterizes factors influencing entry or use. The purpose of this article is to propose a taxonomic definition of "access." Access is presented here as a general concept that summarizes a set of more specific dimensions describing the fit between the patient and the health care system. The specific dimensions are availability, accessibility, accommodation, affordability and acceptability. Using interview data on patient satisfaction, the discriminant validity of these dimensions is investigated. Results provide strong support for the view that differentiation does exist among the five areas and that the measures do relate to the phenomena with which they are identified.
              Article 0 comments Cited 271 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Baylee Crone:
                ORCID: http://orcid.org/0000-0002-7825-0523
                baylee.crone@usuhs.edu
                Journal
                Journal ID (nlm-ta): J Racial Ethn Health Disparities
                Journal ID (iso-abbrev): J Racial Ethn Health Disparities
                Title: Journal of Racial and Ethnic Health Disparities
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 2197-3792
                ISSN (Electronic): 2196-8837
                Publication date (Electronic): 16 August 2021
                Pages: 1-17
                Affiliations
                [1 ]GRID grid.265436.0, ISNI 0000 0001 0421 5525, Uniformed Service University of the Health Sciences, ; Bethesda, MD USA
                [2 ]GRID grid.33489.35, ISNI 0000 0001 0454 4791, University of Delaware, ; Wilmington, DE USA
                [3 ]GRID grid.265436.0, ISNI 0000 0001 0421 5525, Uniformed Service University of the Health Sciences, ; Bethesda, MD USA
                Author information
                http://orcid.org/0000-0002-7825-0523
                Article
                Publisher ID: 1119
                DOI: 10.1007/s40615-021-01119-z
                PMC ID: 8367031
                PubMed ID: 34402040
                SO-VID: 7c754814-bf56-495e-b3ec-96ae5dbc0f0a
                Copyright © © This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2021
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 22 March 2021
                Date revision received : 21 July 2021
                Date accepted : 22 July 2021
                Categories
                Subject: Article

                Keywords: homeless,veteran,health service,health access,health disparities,health model
                Data availability:
                Keywords: homeless, veteran, health service, health access, health disparities, health model

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