May 7, 2009
• Large rise in unmet health care needs among homeless
• Financial and transportation barriers more common in 2005
• Hospitalization more frequent for persons with unmet needs
BIRMINGHAM, Ala. - Homeless persons in Birmingham were much more likely to report inability to obtain health care when needed in 2005 compared to 1995, according to analysis of two community surveys administered 10 years apart and published May 6 in the online edition of the Journal of General Internal Medicine.
Stefan Kertesz, M.D., assistant professor in the UAB Division of Preventive Medicine, and colleagues looked at what homeless persons in Birmingham reported about health care access when surveyed in 1995 and 2005, in nearly identical population surveys supervised by co-authors Mark E. LaGory, Ph.D., and Ferris Ritchey, Ph.D., from the UAB Department of Sociology.
They compared the percentage reporting at least one instance of being unable to obtain health care when needed for 1995 and 2005. They then analyzed if changes in the population might help to explain changes in health care access.
The percentage of Birmingham's homeless reporting they could not obtain care when needed rose from 32 percent in 1995 to 54 percent in 2005. The increase in unmet need was more pronounced for non-blacks and females, among whom more than 60 percent perceived unmet health care needs in 2005.
The size of Birmingham's homeless population did not substantially change from 1995 to 2005. However, Kertesz said his team found that Birmingham's homeless were somewhat older, somewhat more ill and more likely to have longer periods of homelessness in 2005.
Once the team adjusted for these characteristics, the difference between 2005 and 1995 grew more pronounced. Being homeless in 2005 was associated with 2.7 times greater likelihood of having problems accessing health care compared to 1995. Among Birmingham's homeless who reported problems obtaining care in 2005, 45 percent were hospitalized.
"Homeless persons' access to care appears to have seriously declined in Birmingham, and our data show that is absolutely not related to changes in who is homeless," Kertesz said. "Rather, it seems something in the health care environment has changed."
For persons who reported difficulty obtaining care in 2005, the most frequent reported reasons were inability to pay for it, 67 percent, and lack of transportation, 41 percent. Both problems were much less common in 1995, reported among 42 percent and 19 percent, respectively. Only 20 percent of Birmingham's homeless reported receiving health care for free in 2005, compared to 48 percent in 1995.
Kertesz said this study does not measure what types of care were difficult to obtain or indicate what in the health care environment could have changed to cause the increases. He said that it suggests problems in Birmingham's homeless health care safety net as a whole.
"These findings are not encouraging," Kertesz said. "I hope they lead to a rejuvenated focus on assisting this population."
Additional co-authors on the study are Stephen Hwang, M.D., University of Toronto and the Centre for Research on Inner City Health, and Jay Irwin, Ph.D., in the Department of Sociology at UAB.
The study was funded by the National Institute on Drug Abuse. Original survey data collection was supported by grants from the Office of Development, City of Birmingham and the Office of Planning and Community Development of Jefferson County.