Determinants of health care use among homeless individuals: evidence from the Hamburg survey of homeless individuals

Abstract

Background To identify the determinants of health care use among homeless individuals. Methods Data were taken from the Hamburg survey of homeless individuals (n = 100 individuals in the here used model, mean age 44.8 years, SD 12.5) focusing on homeless individuals in Hamburg, Germany. The number of physician visits in the past 3 months and hospitalization in the preceding 12 months were used as outcome measures. Drawing on the Andersen model of health care use as a conceptual framework, predisposing characteristics, enabling resources and need factors as well as psychosocial variables were included as correlates. Results Negative binomial regressions showed that increased physician visits were associated with being female (IRR: 4.02 [95% CI: 1.60–10.11]), absence of chronic alcohol consume (IRR: 0.26 [95% CI: 0.12–0.57]) and lower health-related quality of life (IRR: 0.97 [95% CI: 0.96–0.98]). Furthermore, logistic regressions showed that the likelihood of hospitalization was positively associated with lower age (OR: 0.93 [95% CI: 0.89–0.98]), having health insurance (OR: 8.11 [2.11–30.80]) and lower health-related quality of life (OR: 0.97 [95% CI: 0.94–0.99]). Conclusions Our study showed that predisposing characteristics (both age and sex), enabling resources (i.e., health insurance) and need factors in terms of health-related quality of life are main drivers of health care use among homeless individuals. This knowledge may assist in managing health care use.

A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe

“…Fear or perceived threat of COVID-19 among PEH was discussed by ten studies [ 12 , 13 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 ]. Fear varied across studies; in Los Angeles, 65% of tenants of permanent supportive housing surveyed by Henwood et al [ 85 ] in March 2020 regarded COVID-19 as a serious risk to their health, while 33% of those surveyed in Los Angeles by Kuhn et al [ 87 ] from December 2020 to February 2021 perceived it as a high threat.…”

“…Finnigan [ 86 ] found that 27% of PEH surveyed in Sacramento, California, reported avoiding shelters due to fear of the virus. One study in Hamburg reported increased physician visits or likelihood of hospitalisation was not associated with fear of COVID-19 among PEH [ 82 ].…”

“…Active substance use among PEH during the pandemic was noted in 36 studies [ 8 , 11 , 12 , 13 , 20 , 23 , 25 , 26 , 38 , 47 , 51 , 61 , 62 , 68 , 72 , 76 , 81 , 82 , 84 , 88 , 89 , 92 , 94 , 96 , 99 , 101 , 102 , 103 , 104 , 107 , 108 , 110 , 113 , 114 , 115 ]. Substances used included alcohol [ 8 , 13 , 23 , 25 , 26 , 47 , 61 , 62 , 68 , 72 , 82 , 84 , 88 , 89 , 94 , 99 , 101 , 102 , 108 , 110 …”

“…,51,61,62,68,72,76,81,82,84,88,89,92,94,96,99,101-104,107,108,110,113-115]. Substances used included alcohol[8,13,23,25,26,47,61,62,68,72,82,84,88,89,94,99,101,102,108,110,115], tobacco…”

Determinants of COVID-19 vaccine acceptance and access among people experiencing homelessness in Germany: A qualitative interview study

“…In a Canadian study, more than one-third of the included PEH reported unmet health needs (10). According to a survey from Hamburg (Germany), uninsured PEH (one-third of the included individuals), reported fewer physician visits, again indicating a lack of affordability of health care (11). Matching those findings, a facility enabling access to health care for people without health insurance in Berlin reports 50% of their clients to be home-or roofless (12).…”