How Accessible Is Medical Care for Homeless Women?

Published in: Medical Care, v. 40, no. 6, June 2002, p. 510-520

by Yee-Wei Lim, Ronald Andersen, Barbara Leake, William Cunningham, Lillian Gelberg

Read More

Access further information on this document at

This article was published outside of RAND. The full text of the article can be found at the link above.

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.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.