Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  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.

  2. Gelberg L, Gallagher TC, Andersen RM, Koegel P. Competing priorities as a barrier to medical care among homeless adults in Los Angeles. Am J Public Health. 1997; 87: 217–220.

    Article  CAS  PubMed  Google Scholar 

  3. Kushel MB, Vittingoff E, Haas JS. Factors associated with the health care utilization of homeless persons. JAMA. 2001; 285: 200–206.

    Article  CAS  PubMed  Google Scholar 

  4. Hwang SW, Ueng JJ, Chiu S, et al. Universal health insurance and health care access for homeless persons. Am J Public Health. 2010; 100: 1454–1461.

    Article  PubMed  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.

  7. Church AH, Waclawski J. Designing and Using Organizational Surveys. Brookfield, VT: Gower; 1998.

  8. Baggett TP, O’Connell JJ, Singer DE, Rigotti NA. The unmet health care needs of homeless adults: a national study. Am J Public Health. 2010; 100: 1326–1333.

    Article  PubMed  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.

  11. Darnell JS. Free clinics in the United States: a nationwide survey. Arch Intern Med. 2010; 170: 946–953.

    Article  PubMed  Google Scholar 

  12. Salit SA, Kuhn EM, Hartz AJ, Vu JM, Mosso AL. Hospitalization costs associated with homelessness in New York City. N Engl J Med. 1998; 338: 1734–1740.

    Article  CAS  PubMed  Google Scholar 

  13. Kertesz SG, Hwang SW, Irwin J, Ritchey FJ, Lagory ME. Rising inability to obtain needed health care among homeless persons in Birmingham, Alabama (1995–2005). J Gen Intern Med. 2009; 24: 841–847.

    Article  PubMed Central  PubMed  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 

  17. LaGory M, Ritchey F, Fitzpatrick K. Homelessness and affiliation. Sociol Q. 1991; 32: 201–218.

    Article  Google Scholar 

  18. Gelberg L, Andersen RM, Leake BD. The Behavioral Model for Vulnerable Populations: application to medical care use and outcomes for homeless people. Health Serv Res. 2000; 34: 1273–1302.

    CAS  PubMed  Google Scholar 

  19. Brown RL, Leonard T, Saunders LA, Papasouliotis O. A two-item conjoint screen for alcohol and other drug problems. J Am Board Fam Pract. 2001; 14: 95–106.

    CAS  PubMed  Google Scholar 

  20. Padgett D, Struening EL, Andrews H. Factors affecting the use of medical, mental health, alcohol, and drug treatment services by homeless adults. Med Care. 1990; 28: 805–821.

    Article  CAS  PubMed  Google Scholar 

  21. DeSalvo KB, Fan VS, McDonell MB, Fihn SD. Predicting mortality and healthcare utilization with a single question. Health Serv Res. 2005; 40: 1234–1246.

    Article  PubMed  Google Scholar 

  22. DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. Mortality prediction with a single general self-rated health question. J Gen Intern Med. 2006; 21: 267–275.

    Article  PubMed Central  PubMed  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):1–117

  24. Ferenchick GS. The medical problems of homeless clinic patients: a comparative study. J Gen Intern Med. 1992; 7: 294–297.

    Article  CAS  PubMed  Google Scholar 

  25. Gelberg L, Linn LS, Usatine RP, Smith MH. Health, homelessness, and poverty. A study of clinic users. Arch Intern Med. 1990; 150: 2325–2330.

    Article  CAS  PubMed  Google Scholar 

  26. Bisgaier J, Rhodes KV. Auditing access to specialty care for children with public insurance. N Engl J Med. 2011; 364: 2324–2333.

    Article  CAS  PubMed  Google Scholar 

  27. Cook NL, Hicks LS, O’Malley AJ, Keegan T, Guadagnoli E, Landon BE. Access to specialty care and medical services in community health centers. Heal Aff. 2007; 26: 1459–1468.

    Article  Google 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.

  31. Walsh MW. When a county runs off the cliff. New York Times; 2012; February 19.

  32. Wright JD, Weber E. Homelessness and Health. New York, NY: McGraw-Hill, Inc.; 1987.

    Google Scholar 

  33. Brickner PW, Scanlan BC, Conanan B, et al. Homeless persons and health care. Ann Intern Med. 1986; 104: 405–409.

    Article  CAS  PubMed  Google Scholar 

  34. Cunningham CO, Shapiro S, Berg KM, Sacajiu G, Paccione G, Goulet JL. An evaluation of a medical outreach program targeting unstably housed HIV-infected individuals. Journal of Health Care for the Poor and Underserved. 2005; 16: 127–138.

    Article  PubMed  Google Scholar 

  35. Rosenblum A, Nuttbrock L, McQuistion H, Magura S, Joseph H. Medical outreach to homeless substance users in New York City: preliminary results. Substance Use & Misuse. 2002; 37: 1269–1273.

    Article  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.

  37. Gelberg L, Siecke N. Accuracy of homeless adults' self-reports. Med Care. 1997; 35: 287–290.

    Article  CAS  PubMed  Google Scholar 

  38. Berk ML, Schur CL, Cantor JC. Ability to obtain health care: recent estimates from the Robert Wood Johnson Foundation National Access to Care Survey. Health Aff (Millwood). 1995; 14: 139–146.

    Article  CAS  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).

  40. Graves JA. Medicaid expansion opt-outs and uncompensated care. N Engl J Med. 2012; 367: 2365–2367.

    Article  CAS  PubMed  Google Scholar 

  41. National Health Care for the Homeless Council. HCH quality leaders: a case study. Nashville, TN: National Health Care for the Homeless Council; 2012.

Download references

Acknowledgments

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.

Disclaimer

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.

Author information

Authors and Affiliations

  1. Center for Surgical Medical and Acute Care Research, Birmingham VA Medical Center, Birmingham, AL, USA

    Stefan G. Kertesz

  2. School of Medicine, University of Alabama at Birmingham, 1530 3rd Avenue South MT608, Birmingham, AL, 35294, USA

    Stefan G. Kertesz, Whitney McNeil & Renee Desmond

  3. School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA

    Julie J. Cash

  4. Schools of Medicine and Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Gerald McGwin Jr.

  5. Self Regional Health Care Family Medicine Residency Program, Greenwood, SC, USA

    Jason Kelly

  6. General Medicine Division, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, MA, USA

    Travis P. Baggett

Authors
  1. Stefan G. Kertesz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Whitney McNeil
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julie J. Cash
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Renee Desmond
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gerald McGwin Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jason Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Travis P. Baggett
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefan G. Kertesz.

Additional information

Preliminary findings of this survey, without the statistical analysis, were prepared for the Birmingham Coalition for the Homeless and described in the Birmingham News on 27 September 2010.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kertesz, S.G., McNeil, W., Cash, J.J. et al. Unmet Need for Medical Care and Safety Net Accessibility among Birmingham’s Homeless. J Urban Health 91, 33–45 (2014). https://doi.org/10.1007/s11524-013-9801-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-013-9801-3

Keywords

Search

Navigation