Access to Care

Economic and housing instability are linked to poor access to health care and higher rates of hospitalization

Individuals who are struggling financially and whose housing situation is unstable are likely to have poorer access to health care and more hospitalizations than those in more fortunate circumstances. A new study by University of California, San Francisco researchers found that rates of having no usual source of care were 14.1 to 17.6 percent in the general population, but 26.1 percent in the unstably housed population.

Rates of being uninsured ranged from 16.6 percent in the general population to 30.9 to 36.9 percent in the low-income population, 35.6 percent of the unstably housed, and 55 percent of the homeless population. Rates of postponing medical care ranged from 6.5 to 11.6 percent of the general population to 17.4 percent of the unstably housed population and 24.6 percent of the homeless. Of the low-income population, 7 percent reported postponing getting needed medications versus 13.9 percent of the unstably housed and 32.2 percent of the homeless. Finally, among the general population, 7.3 to 8.5 percent reported being hospitalized within the past 12 months compared with 10.6 percent of the unstably housed and 23.6 percent of the homeless.

These findings were based on analysis of four nationally representative surveys: the Medical Expenditure Panel Survey, the National Health Interview Survey, the National Survey of America's Families, and the National Survey of Homeless Assistance Providers and Clients. The study was supported by the Agency for Healthcare Research and Quality (HS11415).

More details are in "Association between the level of housing instability, economic standing and health care access: A meta-regression," by Kristen W. Reid, M.D., Eric Vittinghoff, Ph.D., M.P.H., and Margot B. Kushel, M.D., in the November 2008 Journal of Health Care for the Poor and Underserved 19, pp. 1212-1228.

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