Journal of Urban Health

, Volume 91, Issue 1, pp 33–45 | Cite as

Unmet Need for Medical Care and Safety Net Accessibility among Birmingham’s Homeless

  • Stefan G. Kertesz
  • Whitney McNeil
  • Julie J. Cash
  • Renee Desmond
  • Gerald McGwinJr.
  • Jason Kelly
  • Travis P. Baggett


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.


Homeless 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.


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Copyright information

© The New York Academy of Medicine (outside the USA) 2013

Authors and Affiliations

  • Stefan G. Kertesz
    • 1
    • 2
  • Whitney McNeil
    • 2
  • Julie J. Cash
    • 3
  • Renee Desmond
    • 2
  • Gerald McGwinJr.
    • 4
  • Jason Kelly
    • 5
  • Travis P. Baggett
    • 6
  1. 1.Center for Surgical Medical and Acute Care ResearchBirmingham VA Medical CenterBirminghamUSA
  2. 2.School of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.School of NursingUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.Schools of Medicine and Public HealthUniversity of Alabama at BirminghamBirminghamUSA
  5. 5.Self Regional Health Care Family Medicine Residency ProgramGreenwoodUSA
  6. 6.General Medicine Division, Massachusetts General Hospital, Department of MedicineHarvard Medical SchoolBostonUSA

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