摘要：Objectives. We assessed the prevalence and predictors of past-year unmet needs for 5 types of health care services in a national sample of homeless adults. Methods. We analyzed data from 966 adult respondents to the 2003 Health Care for the Homeless User Survey, a sample representing more than 436 000 individuals nationally. Using multivariable logistic regression, we determined the independent predictors of each type of unmet need. Results. Seventy-three percent of the respondents reported at least one unmet health need, including an inability to obtain needed medical or surgical care (32%), prescription medications (36%), mental health care (21%), eyeglasses (41%), and dental care (41%). In multivariable analyses, significant predictors of unmet needs included food insufficiency, out-of-home placement as a minor, vision impairment, and lack of health insurance. Individuals who had been employed in the past year were more likely than those who had not to be uninsured and to have unmet needs for medical care and prescription medications. Conclusions. This national sample of homeless adults reported substantial unmet needs for multiple types of health care. Expansion of health insurance may improve health care access for homeless adults, but addressing the unique challenges inherent to homelessness will also be required. An estimated 2.3 to 3.5 million Americans experience homelessness each year. 1 The health problems of homeless people are broad and multidimensional, contributing to excess mortality. 2 – 7 Rates of acute and chronic medical illness are high, in many cases surpassing those of the general population. 8 – 15 More than half of homeless people have a history of mental illness, and the burden of drug and alcohol use is substantial. 8 , 9 Clinically significant dental problems have been identified in two thirds of homeless individuals, 8 and nearly 40% have functional vision impairments. 16 Homeless people also experience poor access to health care, 17 – 21 leading to delayed clinical presentation, 12 increased reliance on emergency departments, 22 and higher rates of hospitalization, 23 often for preventable conditions. 24 Yet, the extent to which homeless adults are able to obtain health care across the spectrum of health needs just described is largely unknown. Existing knowledge is based primarily on studies of single cities 25 , 26 or single types of unmet need 21 , 27 ; very few national surveys have adequately captured this difficult-to-reach population. We used data from a unique national survey of homeless adults to determine the prevalence and predictors of unmet need for 5 types of health services, chosen to reflect multiple domains of health care access. 28 A comprehensive assessment of the unmet health care needs of homeless people can inform policy and practice decisions about how to better provide care to this vulnerable population.
