Homeless Adults Health Care Utilization under Universal Health Insurance in California
A review of the article: A Comprehensive Assessment of Health Care Utilization Among Homeless Adults Under a System of Universal Health Insurance
Hwang, S.W., Chambers, C., Chiu, S., Katic, M., Kiss, A., Redelmeier, D.A., & Levinson, W. (2013). A Comprehensive Assessment of Health Care Utilization Among Homeless Adults Under a System of Universal Health Insurance. American Journal of Public Health, 103(S2), 294- 301. doi: 10.2105/AJPH.2013.301369
(reviewer) Sonia Chavez
Program in Public Health
University of California, Irvine
Irvine, CA 92697
Abstract
Homelessness in the United States is at an all time high with 500,000 adults in the streets
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Introduction Homelessness affects one fifth of the United States population (Hwang et al., 2010). The homeless population experience health conditions at higher rates than the general population and fifty percent of them are uninsured or lack access to health care services (Kar, Kumar, Singh, & Upadhyay, 2015). This study examine the homeless population and examines their level of health care utilization to demonstrate that homeless individuals are intensive users of health services. Tracing the sample population 's health care encounters is critical in and addressing the gaps they face in access to healthcare and understanding the importance of health access as a result of their vulnerable situations. The researchers discovered that homeless people with provincial health cards were accessing health services at high rates, specifically Emergency Department and inpatient hospital visits. Despite the study 's comprehensive assessment of high utilization of health services amongst homeless people, the study is limited by a biased sampling strategy that favored participants with valid provisional health card numbers, use of secondary data analysis, and generalizations due to minimal references to other cities in California. Strengthening
Homelessness has always been a problem for the United States. Since its birth as a nation, there have consistently been individuals who find themselves without a place to live, looking for shelter with family, friends, or simply anywhere they can find it. These individuals have been targeted as candidates for social aid, but this was primarily provided by churches and other care organizations. However, in the past thirty years the homeless population has increased almost exponentially in numbers. While the cause of this is undetermined, it is quite certain that while the
According to the American Journal of Public Health (AJPH), disease was prevalent in the newly homeless. This population accessed health care services at high rates in the year before becoming homeless. Significant improvements in health status were seen over the study period as well as a significant increase in the number who were insured (American Journal of Public Health, 2012). The homeless in Overtown face a variety of risks and barriers to their health. Firstly, a good number of the population suffers from mental illness, they suffer from a range of mental health problems from depression, personality disorders, schizophrenia and many more. Most are unable to treat their mental
The homeless population will only increase with our current economic status. Jean Watson’s Theory of Caring states that “intentionality is the projection of awareness, with purpose and efficacy toward some object or outcome” (Leuning, 2001, p. 300). Healthcare organizations and nurses need to collaborate using intentionality. The vulnerability status of the homeless is higher than most due to their lack of basic human needs of food, water, and shelter. The homeless population succumbs to a variety of chronic illnesses and disease, such as tuberculosis, AIDS/HIV, malnutrition and severe dental problems. They also fall prey to parasites, frostbite, infection and violence (Basics of Homelessness, 2002). These reasons alone prove that the homeless population needs to receive specialized care designed around their lifestyles. As one can see, this population is not going away and the problem will only continue to grow. It is up to nurses and other healthcare professionals to advocate for these individuals and help make a change by using specialized assessment tools and learning more about programs specifically for the homeless By ensuring that these individuals receive the proper follow up care through a collaborative effort of nurses, doctors, social workers, case managers, and psychiatric professionals, there will be a
This type of research involves a qualitative study involving random homeless shelter staff member participants. The variables studied are the obstacles to obtain healthcare in the homeless. The author is studying the services that are attainable for the home along with the limitations of those services. The methodology consists of interview questions and follow-up questions that were recorded. Some of the questions were obtained from The Medical Respite Development Workbook as well as specifically developed for this study. For example some of the questions are; what are the common healthcare needs of the homeless you encounter?; What do you see as barriers to their access of healthcare? (Hauff & Secor, 2014). The major theme that evolved are barriers to healthcare needs among the homeless population due to lack of affordability in medical treatment, medications, education and resources that becomes untreated health problems resulting in higher mortality rates. The findings provoke attention regarding inadequate healthcare needs for the homeless. Community nurses can use this information to further educate
Among general population, homelessness has been a social, economic, and public health concern in the U.S. for at least three decades.
In the United States the homeless population continues to grow rapidly. Homelessness has been a public health issue for many decades. Often times these individuals feel as though society has turned a blind eye to them. This at risk population is seen by society as lazy or chose to live a life on the streets, but if one would examine this population closely would see that there is more to this at risk population than what society has labeled them as. The forces, which affect homelessness, are multifaceted. Social forces such as family breakdown, addictions, and mental illnesses are in combined with structural forces such as lack of low-cost housing, insufficient health services, and poor economic conditions. Many would
The social determinants of health are the conditions in which people are born, grow, live, work, and age (WHO, 2016). This current event relates to the social determinants of health because homelessness has a huge impact on someone’s overall health and quality of life. People who experience homelessness do not have the resources to maintain their health. This can lead to stress, depression, substance abuse, and a number of problems. They are exposed to communicable diseases, malnutrition and many other health issues. Over 500,000 Americans are homeless every night (Kertesz, 2016). This is why we have Health Care for the Homeless programs. The majority of federally funded organizations for the homeless are operated properly. But, there are some
As of January 1, 2011 a survey by the North Carolina Department of Health and Human Services found that 12,371 people identified as homeless individuals of which over 25 percent fell into the third type of homelessness (NC Department of Health and Human Services) and there are three major categories that drive this negative impact. The first category is healthcare. The cost of providing healthcare to the homeless is much higher than low income housed population since the homeless are prone to infectious and chronic diseases but do not have regular visits with the doctor
Homelessness is a social issue that continues to negatively affect individuals, families, and communities across Australia. In 2015, the Australian Bureau of Statistics [ABS] reported 351,000 people experienced homelessness in the preceding 12 months, with approximately 28% of these being homeless for 6 months or longer (ABS, 2015). The multifaceted nature of homelessness means people face complex challenges as they try to navigate a way out of homelessness (Miller & Appleton, 2015). Yet, there has been a shortage of research focused on health care usage amongst homeless people (Beijer & Andréasson, 2009). This study aims to gain a better understanding of the intersection between health and homelessness in the Cairns region of north Queensland.
The most recent survey of homeless individuals conducted January 29, 2014 revealed 958 homeless adults with no dependants, 70 of which were completely unsheltered, and an additional 130 homeless adults who also had dependent children with them. 208 of these homeless adults are chronically homeless (HUD’s 2014 Continuum of Care Homeless Assistance Programs, Populations, and Subpopulations, 2014).Wayside Christian Mission reaches approximately 7,000 homeless individuals annually (Wayside Christian Mission, 2007). In the Journal of General Internal Medicine, a majority of homeless individuals surveyed stated that they felt discriminated against or that they received lesser care because of their poverty or homelessness (Wen, Hudak, & Hwang, 2007). Homeless and impoverished individuals suffer from high rates of depression, psychiatric illness, alcohol and or substance abuse, HIV/AIDS, TB, Trauma, preterm birth, COPD, low birth weight, musculoskeletal problems, decreased access to care, foot problems, malnutrition, and high Emergency Room utilization (Stanhope & Lancaster, 2014). Not only do homeless persons have a high rate of illness, but they are also less able to appropriately treat health problems. Many homeless individuals have limited access to care, cannot afford medications or nutritious food, and may have difficulty with managing a strict
There is one federally funded program in which we will talk about later that helps homeless individuals get the care they need. There is a dire need for more programs that assist the homeless because the number one reason they are homeless is because they cannot afford housing. If they cannot afford this they probably will not be able to afford the necessities to live a healthy lifestyle. When youths and adolescents succumb to homelessness they are at a greater risk, because they do not have the resources an adult would. They have a disadvantage of employment opportunities and are a greater risk of not completing high school. Youths will lack the ability to receive health care, which will create problems in their overall health because they will not be able to receive the care they need in the instance of sickness, injury or access to medicines. There are countless reasons that adults succumb to being homeless. Some are that a job was lost, mental health is prevalent among them, substance abuse and spouse abuse. Adults who are experiencing homelessness have some of the same problems that youths do as well. An adult not being able to receive health care is very serious especially for older homeless adults. Sickness and serious health problems are more prevalent in older adults resulting in untimely death and the spreading of sicknesses and diseases. I have some establishments offering free haircuts to the homeless if they are preparing for an interview. I have also
Homelessness and substance abuse are often two problems that continue to be linked together. According to the Substance Abuse and Mental Health Administration (2011), research conducted in the past five years indicates that about 50% of those who are homeless have co-occurring substance abuse problems. Along with co-occurring substance abuse problems, there continues to be other problems such as treatment access to those who are homeless. In this paper we will explore research on the homeless population in relation to substance abuse, and effective interventions on an individual level.
The homeless are a vulnerable population. They are defined by the U.S. Department of Health and Human Services as “an individual who lacks housing (without regard to whether the individual is a member of a family), including an individual whose primary residence during the night is a supervised public or private facility (e.g., shelters) that provides temporary living accommodations, and an individual who is a resident in transitional housing.” (The National Health Care for the Homeless Council, 2016). They are a social group throughout the US who are susceptible to all of the life’s cruelties. They are much more at risk for adverse illnesses due to their lack of available resources and medical help. Many have predetermined illnesses which need daily treatment but cannot acquire the medication needed. The homeless population lacks the funding for life’s necessities, thus the luxury of insurance and medicine is a dream.
As many as 3.5 million Americans are considered homeless each year. Often, people believe that homelessness is a complication only caused by the poor choices of a single person when they are typically the result of multiple uncontrollable factors. For some, the line between being homeless and not can be very thin, with several obstacles preventing stability. These individuals and families commonly come from more deprived areas. Those who are homeless can be very different to each other in how and why they came to be in their situation, but they all have in common their desire to find a way back to a normal and healthy lifestyle. Homelessness is an issue created by poor physical and mental health, a lack of money, and relationship complications.
Throughout history there has always been a portion of society living in disadvantaged conditions. With the current high cost of living, global issues, unemployment rate on the rise, and low wages, many Americans are finding themselves homeless. One would think that in this advanced century, there would not be individuals living without the basic necessities such as food, water, and shelter. Unfortunately, there are millions of people with nowhere to sleep. Besides the many problems homeless people face daily, one of the leading problems is health care. Being homeless with limited access to health care or shelter in conjunction with mental illness or exposure to harmful diseases can lead to poor health, or