title: Universal health insurance and health care access for homeless persons.
abstract: 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.
authors.affiliation: Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada. hwangs@smh.ca
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
authors.forename: Joanna J M
authors.initials: JJ
authors.lastname: Ueng
authors.forename: Shirley
authors.initials: S
authors.lastname: Chiu
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.forename: George
authors.initials: G
authors.lastname: Tolomiczenko
authors.forename: Laura
authors.initials: L
authors.lastname: Cowan
authors.forename: Wendy
authors.initials: W
authors.lastname: Levinson
authors.forename: Donald A
authors.initials: DA
authors.lastname: Redelmeier
mesh_terms: 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