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The State of Healthcare for the Homeless

Homelessness remains a national crisis in the U.S. Recent estimates via the Department of Housing and Urban Development show that there are still 552,830 homeless people across the country. The report also notes that the number of people in unsheltered locations have been increasing over the last three years. Homeless people have little to no access to healthcare in this country. This is despite well-established facts that homeless people face much higher risks of adverse health outcomes compared to the average U.S. citizen. While there are programs in place and charities at work to address this, evidence suggests that there are still institutional and social barriers to their access to health services.

Health disparities

The direct relationship between homelessness and healthcare access is widely documented. The prevalence of chronic conditions such as cancer, heart disease, and mental health problems are disproportionately higher in homeless people than the national average. Behavioral health issues, having no shelter, and a higher risk of violence exacerbate their conditions.

Infections, injuries, and other acute conditions fester when you don’t have shelter. At the same time, communicable diseases such as tuberculosis, AIDS, and hepatitis easily spread through homeless populations. In fact, people without a residence have been documented to use the emergency room (ER) up to three times more in a year compared to the average American. Death among homeless youth is also acutely higher than their housed counterparts. In short, homelessness is a public health issue – one that is grossly unaddressed.

Affordability and access

The financial burden and hurdles that come with obtaining health insurance remain the top obstacles for homeless people to access healthcare outside emergencies. As most health insurance is derived through employer-based plans, and most homeless are unemployed, that leaves a majority of homeless without access to insurance-based healthcare. The solution for this is to link them to Medicaid, which is a main strategy of homeless service providers. A statistical brief from the Healthcare Cost and Utilization Project found that 72.1% of ER visits by homeless people were paid primarily through Medicaid. The brief also mentions that while there are many local community clinics, 86% of ER visits by homeless people were made to teaching hospitals. This is compounded by a shortage in primary care physicians especially in rural and inner-city communities. Maryville University predicts that this shortage will reach a minimum of 100,000 by 2025, which will make it much harder for those on the street to reach a hospital for the treatment they need. Additionally, the recent threats to the continued expansion of Medicaid will only aggravate these barriers for the homeless.

Hidden Barriers There’s a lot of literature that tackles how the lack of housing and insurance inadvertently affects healthcare access among homeless people. There are also hidden barriers that, while derivative, are contributing to their dire conditions. Researchers from the Ohio State University College of Medicine found that logistical barriers outweigh all other hurdles to homeless healthcare access among youth. One in three homeless youth surveyed reported transportation as the top reason why they don’t go to local community clinics. Other logistical hindrances cited include lack of knowledge about local specialized homeless clinics, and lack of accompaniment. Another striking finding shows that fear-based barriers such as social stigmas, distrust of the healthcare system, and protection of privacy remain in force among young homeless people.

Way forward

Precarious living and poverty are the underlying roots of chronic homelessness and low access to health services. For many, the daily struggle for shelter, food, and clothing distances health as a priority. Individuals with complex medical needs often have difficulty in maintaining housing. This is why more initiatives like the Renaissance Flexible Housing Pool and other Housing First integrated programs are needed. By prioritizing housing as a first step and linking it with wrap-around support services, these strategic initiatives can better tackle the healthcare access problem with long-term and holistic solutions. The lack of healthcare access for homeless people is a systematic problem, and it can only be fully addressed by introducing major changes to the current systems that allow it to prevail.

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