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Providing homeless women with health insurance and a regular source of care may greatly improve their access to care

Homeless women, who made up 42 percent of the homeless population in 1999, are a vulnerable group plagued by mental illness and a history of physical, sexual, and substance abuse. Not only do they have poorer health and less insurance than other women, but they also have far less access to all types of medical care, finds a study supported in part by the Agency for Healthcare Research and Quality (HS08323). Providing these women with health insurance, clinics that they can visit regularly, and outreach programs for homeless women living on the streets should improve these women's access to care, concludes Lillian Gelberg, M.D., M.S.P.H., of the University of California, Los Angeles.

Dr. Gelberg and her UCLA colleagues interviewed 974 homeless women in Los Angeles County, who were recruited from homeless shelters and soup lines, about their number of hospitalizations, outpatient visits, and preventive health screens in the past year. Only 61 percent of homeless women overall had a regular source of care, and 47 percent had no health insurance, yet one-third reported that they were in poor or fair health. Homeless women were 33 percent more likely to use outpatient care if they had a regular source of care, especially a particular provider that they saw. Having health insurance nearly tripled their likelihood of being hospitalized.

Homeless women living on the streets were less likely than women who stayed in shelters and traditional housing to have been hospitalized (21 vs. 28 and 38 percent, respectively) or to have had outpatient visits (3.7 vs. 7.2 and 7.4 visits) or health screens in the past year (2.9 vs. 3.6 and 3.6 out of 4 screens). These women also were significantly more likely to report poor or fair health (61 percent) than homeless women who stayed in shelters and traditional housing (31 and 37 percent, respectively). Finally, women who spent most of their time on the streets had less social contacts and were only one-third as likely to have health insurance as other homeless women.

See "How accessible is medical care for homeless women?" by Yee Wei Lim, M.B.B.S., Ronald Andersen, Ph.D., Barbara Leake, Ph.D., and others, in the June 2002 Medical Care 40(6), pp. 510-520.

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