Universal health insurance and health care access for homeless persons.
OBJECTIVE
We examined the extent of unmet needs and barriers to accessing health care among homeless people within a universal health insurance system.


METHODS
We randomly selected a representative sample of 1169 homeless individuals at shelters and meal programs in Toronto, Ontario. We determined the prevalence of self-reported unmet needs for health care in the past 12 months and used regression analyses to identify factors associated with unmet needs.


RESULTS
Unmet health care needs were reported by 17% of participants. Compared with Toronto's general population, unmet needs were significantly more common among homeless individuals, particularly among homeless women with dependent children. Factors independently associated with a greater likelihood of unmet needs were younger age, having been a victim of physical assault in the past 12 months, and lower mental and physical health scores on the 12-Item Short Form Health Survey.


CONCLUSIONS
Within a system of universal health insurance, homeless people still encounter barriers to obtaining health care. Strategies to reduce nonfinancial barriers faced by homeless women with children, younger adults, and recent victims of physical assault should be explored.
Hwang
Stephen W
SW
Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada. hwangs@smh.ca
Ueng
Joanna J M
JJ
Chiu
Shirley
S
Kiss
Alex
A
Tolomiczenko
George
G
Cowan
Laura
L
Levinson
Wendy
W
Redelmeier
Donald A
DA
D000328:Adult; D000704:Analysis of Variance; D015984:Causality; D002648:Child; D005260:Female; D015438:Health Behavior; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration*; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology; D009313:National Health Programs / Q000458:organization & administration*; D020380:Needs Assessment / Q000458:organization & administration*; D009864:Ontario / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D015995:Prevalence; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology; D011795:Surveys and Questionnaires; D019472:Universal Health Insurance / Q000458:organization & administration*; D019037:Urban Health Services / Q000458:organization & administration; D035862:Vulnerable Populations / Q000523:psychology / Q000706:statistics & numerical data