How Accessible Is Medical Care for Homeless Women?

BACKGROUND. Women have become a major segment of the homeless population, yet little is known about their access to health care or the relationship between access to care and vulnerability of homelessness. OBJECTIVE. To examine homeless women's access to health care using the Expanded Behavioral Model for Vulnerable Populations. RESEARCH DESIGN. Population-based cross-sectional study using a probability sample of homeless women. SETTING. Seventy-eight homeless shelters and soup lines in Los Angeles County. SUBJECTS. Nine hundred seventy-four homeless women interviewed between January and October of 1997. OUTCOME MEASURES. Hospitalization, not for delivery, in the past 12 months; number of outpatient visits in the past 12 months; and number of preventive health screens in the past 12 months. RESULTS. Among homeless women, those living on the streets were least likely to be hospitalized and had the fewest ambulatory visits and health screens. Multivariate analyses showed that key enabling factors associated with improved access were having: (1) health insurance, which increased the odds of being hospitalized by almost 3 times, and the number of ambulatory visits received; and (2) a regular source of care which increased the number of outpatient visits and health screens (all at P <0.01). CONCLUSIONS. The findings from the analysis of this large representative sample of homeless women indicate that women living on the streets have especially limited access to all types of medical care. The provision of health insurance and a regular source of care may substantially improve access for this vulnerable population.