Unmet Need for Medical Care and Safety Net Accessibility among Birmingham’s Homeless
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Although homeless individuals often experience health problems requiring care, there are limitations to available research concerning the scale of their needs and the accessibility of safety net agencies to meet them. Traditional access-to-care surveys calculate unmet need among all persons queried (rather than persons needing care), making it difficult to calculate what percentage of persons requiring care actually obtain it. Additionally, no research has compared the relative accessibility of safety net programs to homeless persons in need. This cross-sectional, community-based survey assessed the prevalence of unmet need for several specific types of health care and compared the accessibility of agencies in Birmingham, AL. Substantial proportions of respondents reported unmet needs for general medical care (46 %), specialty care (51 %), mental health care (51 %), dental care (62 %), medications (57 %), and care of a child (23 %). The most commonly mentioned sites where care was sought included a federally funded Health Care for the Homeless (HCH) program (59 %), a religious free clinic (31 %), and a public hospital emergency department (51 %). The HCH program was most commonly cited as the location where care, once sought, could not be obtained (15 %), followed by the county hospital primary care clinics (13 %). In this survey, unmet need was common for all types of care queried, including primary care. Key components of the safety net, including a federally funded homeless health care program, had suboptimum accessibility.
KeywordsHomeless persons Safety net Primary care Survey research
The authors wish to express their appreciation to Anand Iyer, M.D., for his help in the design of the original survey and to the University of Alabama’s Survey Research Unit and its Director, Dr. Hermann Foushee, for helping set up the data input and storage system. The authors thank the Center for Clinical and Translational Science at University of Alabama at Birmingham for the service offered by Gerald McGwin. The authors also thank the collaborating homeless shelters of Birmingham, AL. Funds to cover the cost of incentive gifts and printing were provided by the University of Alabama at Birmingham School of Medicine.
The opinions expressed in this manuscript are those of the authors and do not reflect the opinions or positions of the US Federal Government or the Department of Veterans Affairs.
- 1.United States Department of Housing and Urban Development. The 2010 annual homeless assessment report to Congress. Washington, DC: United States Department of Housing and Urban Development; 2010.Google Scholar
- 5.Strunk BS, Cunningham PJ. Trends in Americans' access to needed medical care, 2001–2003. Washington, DC: Center for Studying Health System Change; 2004.Google Scholar
- 6.US Department of Health and Human Services; Centers for Disease Control and Prevention; National Center for Health Statistics. National Health Interview Survey, 1995: access to care supplement. ICPSR version. Hyattsville, MD: Inter-university Consortium for Political and Social Research; 1998.Google Scholar
- 7.Church AH, Waclawski J. Designing and Using Organizational Surveys. Brookfield, VT: Gower; 1998.Google Scholar
- 9.Perl L, Fernandes AL, Laney GP, et al. Homelessness: targeted federal programs and recent legislation. Washington, DC: Congressional Research Service; 2009.Google Scholar
- 10.Health Centers Consolidation Act of 1996. United States of America; 1996.Google Scholar
- 14.Hansen J. Study of Birmingham homeles finds heath care needs as summit on problem begins. Birmingham News. 2010; August 27. http://blog.al.com/spotnews/2010/08/study_of_birmingham_homeless_f.html.
- 15.LaGory M, Ritchey FJ, Fitzpatrick K, Irwin J. A needs assessment of the homeless of Birmingham and Jefferson county. Birmingham: University of Alabama at Birmingham; 2005.Google Scholar
- 16.Ritchey FJ, Lagory ME, Fitzpatrick KM, Hale T, Irwin J. Report of results of the Birmingham, Alabama Metropolitan Area Survey of Homeless Persons, January 27–28, 2005. Birmingham: University of Alabama at Birmingham; 2005.Google Scholar
- 23.Adams PE, Martinez ME, Vickerie JL, Kirzinger WK. Summary health statistics for the U.S. population: National Health Interview Survey, 2010. Vital Health Stat. 2011;(251):1–117Google Scholar
- 28.Katz AB, Felland LE, Hill I, Stark LB. A long and winding road: federally qualified health centers, community variation and prospects under reform. Washington, DC: Center for Studying Health System Change; 2011.Google Scholar
- 29.Institute of Medicine. America’s health care safety net: intact but endangered. Washington, DC: National Academies; 2000.Google Scholar
- 30.Patient Protection and Affordable Care Act. United States of America; 2010.Google Scholar
- 31.Walsh MW. When a county runs off the cliff. New York Times; 2012; February 19.Google Scholar
- 32.Wright JD, Weber E. Homelessness and Health. New York, NY: McGraw-Hill, Inc.; 1987.Google Scholar
- 36.National Health Care for the Homeless Council. Analysis of health resources and services administration uniform data set (unpublished data). Nashville, TN: National Health Care for the Homeless Council; 2012.Google Scholar
- 39.Oliver M. Primary care doctors leaving Cooper Green during bumpy transition. http://blog.al.com/spotnews/2012/12/primary_care_doctors_leaving_c.html (2012).
- 41.National Health Care for the Homeless Council. HCH quality leaders: a case study. Nashville, TN: National Health Care for the Homeless Council; 2012.Google Scholar