Abstract
Homeless individuals have many negative experiences with inequality regarding access to and the use of primary healthcare services, so policies to eliminate the disparities in and barriers to primary care access for these people are needed. The aim of this study was to explore the use and determinants of free hospital outpatient services for homeless people, in order to describe the provision of free healthcare policies for this vulnerable population in Taipei. One cross-sectional survey was conducted to recruit homeless people aged 45 years old and over in Taipei in 2018. A structured questionnaire was used, and face-to-face interviews were conducted by three social workers to collect the data. Finally, 129 participants were recruited in the study. The results show that 81.4% of the homeless people had made free hospital outpatient care visits (mean = 5.9 visits) in the last three months. An unadjusted logistic regression analysis showed that those homeless people who reported having usual healthcare providers, with higher depressive symptom scores, who used medication and had been hospitalized within one year, and had more chronic diseases, were significantly more likely to make free hospital outpatient visits. The adjusted logistic regression model indicates that homeless people with severe depressive symptoms (odds ratio (OR) = 9.32, 95% CI = 1.15–56.07), who had received medication (OR = 3.93; 95% CI = 1.06–14.52), and who had more than five chronic diseases (OR = 1.06, 95% CI = 1.35–13.27), were significantly more likely to make free hospital outpatient visits than their counterparts. The findings highlight that homeless people have higher healthcare requirements than the general population, and the healthcare system should pay more attention to factors associated with higher outpatient service use, such as homelessness, severe depressive symptoms, the receipt of medication and chronic diseases.
Highlights
Homelessness is a major public health problem that requires special attention in society [1]
Many of the homeless individuals needed to return to healthcare facilities for further checks, and age was associated with depressive symptoms among middle-aged and older homeless adults [18]
For the adjusted logistic regression model, which controls for the significant variables in the unadjusted analysis, the results indicate that homeless people with severe depression symptoms (OR = 9.32, 95% CI = 1.15–56.07), those who received medication (OR = 3.93; 95% CI = 1.06–14.52), and those with more than five chronic diseases (OR = 1.06, 95% CI = 1.35–13.27), were more significantly associated with a high frequency of free hospital outpatient visits than their counterparts
Summary
Homelessness is a major public health problem that requires special attention in society [1]. There is a need for public health and policy efforts that support healthcare systems for homeless persons, so as to reduce disparities in primary care accessibility and improve health outcomes for this population [3]. In a nationally representative survey in the United States, homeless persons reported severe barriers to needed care and used acute hospital-based care at high rates [4]. Compared with the general population, homeless people report worse mental health, and represent a vulnerable group
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