Sitting in the waiting room: do people experiencing homelessness underutilize health services?

ABSTRACT

Homeless persons tend to have poorer health than the broader population, and thus have a greater need for health services. However, due to resource constraints impeding access to health care, and the chaotic nature of living as a homeless person, this most disadvantaged group may face greater difficulties accessing health services. We use an Australian panel survey, Journeys Home, to contrast health service use by people experiencing homelessness with service use by a similarly vulnerable, yet formally housed group where we can also control for health-related needs. The paper measures the extent to which transitional and enduring homelessness is related to health service usage controlling for differences in health needs; and investigates whether any differences confirm prior research findings which suggest that individuals suffering homelessness are heavy users of support services (e.g., hospital admissions) but light users of primary health services (e.g., general practitioners (GPs) and dentists) that are an important gateway to specialist services.

KEYWORDS:

• Homelessness
• health services
• health care needs

Disclosure statement

No potential conflict of interest was reported by the authors.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1. An enduring homeless status is evident in 11.5% (799) of the total 6917 person-wave observations in the JH Survey, transitional homeless status is evident in 21% (1451) and the formally housed account for the other 67.5% (4667).

2. A logistic regression of the probability of being flagged as “homeless” or “at risk of homelessness” was estimated; those non-flagged individuals with predicted probabilities that place them in the highest 2% of all Centrelink clients were added to the group vulnerable to homelessness.

3. Social security comprises the panoply of Australian Federal Government income support programs that include pensions, for example, elderly, single parent and disability pensions, as well as assistance payments to groups such as the unemployed (called Newstart Allowance during the study period) and those with low income, rent assistance for example.

4. As Padgett et al. (1990, p. 816) conclude from their study of homeless persons use of medical services: “Where respondents sought help is notable for the heavy reliance on hospitals rather than clinics, mental health centers, and other sources of ambulatory care. While this may be due to greater severity of medical and mental health problems, it is also likely that non-availability and inaccessibility of outpatient services are problems for this population. As with many of this country’s poor, the only avenues for help are the emergency rooms of public medical and psychiatric hospitals.”

5. When looking at service use over the preceding six months, homelessness status is determined at the interview, and the enduring category is defined as those homeless without interruption over the preceding six months contemporaneous with reported service use. The remaining homeless are assigned to the transitional group. Analyzing service use over the preceding 12 months, we use the homelessness experience over the second half of that year to determine those assigned to the enduring category. Finally, when looking at service use over the entire three-year observation window, JH participants’ homeless status is determined at the wave 6 interview, and their homelessness experience in the preceding six months is used to determine whether they belong to the enduring or transitional categories of the homeless.

6. Appendix Table A2 shows that the comparison group has a mean of 1.6 diagnosed physical health conditions. The transitional and enduring homeless JH participants have mean of 1.7 and 1.9 diagnosed physical health conditions, respectively. Fifty-three percent of the enduring homeless reports a long-term health condition, impairment or disability, causing restrictions in everyday activities.

7. Model estimates for health needs, predisposing and enabling characteristics are very similar to the results from the earlier model specification presented in Appendix Table A3. However, these can be obtained from the authors on request.

8. The AME from all four interactions is negative (see Table 5).

Additional information

Notes on contributors

Rosanna Scutella

Dr Rosanna Scutella Rosanna is Senior Research Fellow at the Social and Global Studies Centre at RMIT University. Prior to that she was a Senior Research Fellow at MIAESR and the Deputy Project Director of Journeys Home: A Longitudinal Study of Factors Affecting Housing Stability. Her main field of interest can be broadly described as social economics – the application of economic tools and techniques to help understand important social policy issues. More recently her research has focused on homelessness and housing instability.

As project director of Journeys Home Rosanna developed considerable expertise in longitudinal data collection and analysis on a particularly vulnerable population, which also involved analysis of Centrelink administrative data. She has also developed expertise in (quasi)experimental methods with her involvement in a randomized control trial of Individual Placement and Support for youth with severe mental illness and a quasi-experimental assessment of the net benefits of residing in social housing for Infrastructure Victoria.

In addition to her academic work Rosanna has also accumulated extensive experience in real-world settings in the not-for-profit and government sectors. In these roles she was exposed to the broader State and Federal policy environment on a range of social policy areas including housing, education and training, community development, and human services.

Gavin Wood

Professor Gavin Wood Gavin is Emeritus Professor of Housing and Urban Research at RMIT. His main research interests are in urban and housing economics. He has published over 60 refereed journal articles, and acts as a referee for numerous academic journals and research councils. He is currently on the International Editorial Advisory Board of Urban Studies and was a member of the Research Approvals Committee of the UK Economic and Social Research Council’s Urban Big Data Centre 2015–2017.

Gavin has experience in conducting evaluation studies with respect to a wide range of housing and urban policy programs. Gavin has consulted on housing and urban policy issues to a number of organizations overseas including: The Urban Affairs Division of the Organisation for Economic Cooperation and Development (OECD), the Ministerio de Obras Publicas Y Urbanismo, Madrid in Spain, and the Northern Ireland Housing Executive in the UK. In Australia he advised the Office of Fair Trading (Western Australia) on regulatory issues in private rental housing, and in the early 2000s he was a member of the Commonwealth Department of Family and Community Services Panel of Experts on Housing, and a member of the Western Australia Housing Advisory Committee of the Ministry of Housing, WA State Government.

Guy Johnson

Professor Guy Johnson Professor Johnson has been involved in the area of housing and homelessness for over two decades. His research investigates theoretical and applied questions relating to the dynamics of homelessness and housing. His research has contributed extensively to government policy and agency practice that address the housing and support needs of disadvantaged and low-income households. He has coauthored a number of books, over 50 reports, and refereed papers, as well as 8 book chapters. He has served on numerous Government committees and advisory bodies, and is a regular presenter at public and policy forums.

Professor Johnson is recognized nationally and internationally as a leader in innovative policy and practice relevant research. He is currently an Honorary Principal Research Fellow at The Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, and in 2015 spent 12 months in the US as a Visiting Scholar at the School of Social Policy and Practice, University of Pennsylvania.