Factors associated with the health care utilization of homeless persons

Context Homeless persons face numerous barriers to receiving health care an d have high rates of illness and disability. Factors associated with health care utilization by homeless persons have not been explored from a nationa l perspective. Objective To describe factors associated with use of and perceived barriers to receipt of health care among homeless persons. Design and Setting Secondary data analysis of the National Survey of Homele ss Assistance Providers and Clients. Subjects A total of 2974 currently homeless persons interviewed through hom eless assistance programs throughout the United States in October and Novem ber 1996. Main Outcome Measures Self-reported use of ambulatory care services, emerge ncy departments, and inpatient hospital services; inability to receive nece ssary care; and inability to comply with prescription medication in the pri or year. Results Overall, 62.8% of subjects had 1 or more ambulatory care visits dur ing the preceding year, 32.2% visited an emergency department, and 23.3% ha d been hospitalized. However, 24.6% reported having been unable to receive necessary medical care. Of the 1201 respondents who reported having been pr escribed medication, 32.1% reported being unable to comply, After adjustmen t for age, sex, race/ethnicity, medical illness, mental health problems, su bstance abuse, and other covariates, having health insurance was associated with greater use of ambulatory care (odds ratio TOR], 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). Conclusions In this nationally representative survey, homeless persons repo rted high levels of barriers to needed care and used acute hospital-based c are at high rates. Insurance was associated with a greater use of ambulator y care and fewer reported barriers. Provision of insurance may improve the substantial morbidity experienced by homeless persons and decrease their re liance on acute hospital-based care.