Customize your JAMA Network experience by selecting one or more topics from the list below.
Kushel MB, Vittinghoff E, Haas JS. Factors Associated With the Health Care Utilization of Homeless Persons. JAMA. 2001;285(2):200–206. doi:https://doi.org/10.1001/jama.285.2.200
Author Affiliations: Division of General Internal Medicine, San Francisco General Hospital, Department of Medicine (Drs Kushel and Haas), Department of Epidemiology and Biostatistics (Dr Vittinghoff), Institute for Health Policy Studies (Dr Haas), University of California, San Francisco.
Caring for the Uninsured and Underinsured Section
Editors: William L. Roper, MD, MPH, University of North Carolina at
Chapel Hill; Carin M. Olson, MD, Contributing Editor, JAMA.
Context 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
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 Homeless Assistance
Providers and Clients.
Subjects A total of 2974 currently homeless persons interviewed through homeless
assistance programs throughout the United States in October and November 1996.
Main Outcome Measures 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.
Results 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).
Conclusions 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
Create a personal account or sign in to: