Homeless persons face numerous barriers to receiving health care and have high rates
of illness and disability. Factors associated with health care utilization by homeless
persons have not been explored from a national perspective.
To describe factors associated with use of and perceived barriers to receipt of health
care among homeless persons.
Secondary data analysis of the National Survey of Homeless Assistance Providers and
Clients.
A total of 2974 currently homeless persons interviewed through homeless assistance
programs throughout the United States in October and November 1996.
Self-reported use of ambulatory care services, emergency departments, and inpatient
hospital services; inability to receive necessary care; and inability to comply with
prescription medication in the prior year.
Overall, 62.8% of subjects had 1 or more ambulatory care visits during the preceding
year, 32.2% visited an emergency department, and 23.3% had been hospitalized. However,
24.6% reported having been unable to receive necessary medical care. Of the 1201 respondents
who reported having been prescribed medication, 32.1% reported being unable to comply.
After adjustment for age, sex, race/ethnicity, medical illness, mental health problems,
substance abuse, and other covariates, having health insurance was associated with
greater use of ambulatory care (odds ratio [OR], 2.54; 95% confidence interval [CI],
1.19-5.42), inpatient hospitalization (OR, 2.60; 95% CI, 1.16-5.81), and lower reporting
of barriers to needed care (OR, 0.37; 95% CI, 0.15-0.90) and prescription medication
compliance (OR, 0.35; 95% CI, 0.14-0.85). Insurance was not associated with emergency
department visits (OR, 0.90; 95% CI, 0.47-1.75).
In this nationally representative survey, homeless persons reported high levels of
barriers to needed care and used acute hospital-based care at high rates. Insurance
was associated with a greater use of ambulatory care and fewer reported barriers.
Provision of insurance may improve the substantial morbidity experienced by homeless
persons and decrease their reliance on acute hospital-based care.