Healthcare inequities and barriers to access for homeless individuals: a qualitative study in Barcelona (Spain)

Abstract

Background In Spain, homeless individuals have lower perceived quality of health than the rest of the population and their life expectancy is 30 years lower than the national average. While the Spanish health system provides universal access and coverage, homeless individuals do not access or use public care enough to maintain their health. The objective of this study is to determine if homeless individuals can access public health services in conditions of equality with the rest of the population, as established in healthcare legislation, and to better understand the causes of observed inequalities or inequities of access. Methods A detailed qualitative study was carried out in the city of Barcelona (Spain) from October 2019 to February 2020. A total of nine open and in-depth interviews were done with homeless individuals along with seven semi-structured interviews with key informants and two focus groups. One group was composed of eight individuals who were living on the street at the time and the other consisted of eight individuals working in healthcare and social assistance. Results The participants indicated that homeless individuals tend to only access healthcare services when they are seriously ill or have suffered some kind of injury. Once there, they tend to encounter significant barriers that might be 1) administrative; 2) personal, based on belief that that will be poorly attended, discriminated against, or unable to afford treatment; or 3) medical-professional, when health professionals, who understand the lifestyle of this population and their low follow-through with treatments, tend towards minimalist interventions that lack the dedication they would apply to other groups of patients. Conclusions The conclusions derived from this study convey the infrequent use of health services by homeless individuals for reasons attributable to the population itself, to healthcare workers and to the entire healthcare system. Accordingly, to reduce inequities of access to these services, recommendations to healthcare service providers include adapting facilities to provide more adequate care for this population; increasing sensitivity/awareness among healthcare workers; developing in situ care systems in places where the homeless population is most concentrated; and establishing healthcare collaboration agreements with entities that work with this population.

The healthcare inequality among middle-aged and older adults in China: a comparative analysis between the full samples and the homogeneous population

“…It should be noted that, as it is important to address the needs of the overall population, directing special attention to disadvantaged groups which is in low socioeconomic status. It is the key to ensure equality [ 6 ] in healthcare services. The elderly, as a group most in need of medical resources, should receive attention.…”

The sociodemographic characteristics and social determinants of visual impairment in a homeless population in the Montreal area

“…While eye examinations are fully covered for those who have healthcare coverage and welfare benefits, there is an important distinction between having availability and accessibility of healthcare services. Barriers such as fear of stigmatization from healthcare professionals, transportation difficulties, bureaucracy within the public healthcare system, lack of understanding of their rights, and eye health being a low priority for homeless individuals can contribute to this gap (Cernadas & Fernández, 2021 ; Ramsay et al, 2019 ). Individuals experiencing homelessness may not seek treatment until an issue incapacitates them, as other survival needs, including food and shelter, take precedence (Cernadas & Fernández, 2021 ; Hwang, 2001 ).…”

“…Barriers such as fear of stigmatization from healthcare professionals, transportation difficulties, bureaucracy within the public healthcare system, lack of understanding of their rights, and eye health being a low priority for homeless individuals can contribute to this gap (Cernadas & Fernández, 2021 ; Ramsay et al, 2019 ). Individuals experiencing homelessness may not seek treatment until an issue incapacitates them, as other survival needs, including food and shelter, take precedence (Cernadas & Fernández, 2021 ; Hwang, 2001 ). As such, in order to reduce health inequities among individuals experiencing homelessness, healthcare delivery, including optometry services, may have to be adapted for and targeted towards such individuals.…”

Using financial incentives to support service engagement of adults experiencing homelessness and mental illness: A qualitative analysis of key stakeholder perspectives

“…Adults experiencing homelessness and mental illness face significantly worse health and health outcomes compared to the general population, including increased prevalence and severity of chronic health conditions, comorbid alcohol and substance use disorders, neurocognitive impairment and premature mortality 1–3 . Engaging this population in health services is challenging due to transiency in housing, complex health needs, financial barriers, limited availability of tailored and appropriate services and stigma and discrimination 4–8 . In addition, the literature on interventions to improve service engagement among adults experiencing homelessness and mental illness is limited.…”

“… 1 , 2 , 3 Engaging this population in health services is challenging due to transiency in housing, complex health needs, financial barriers, limited availability of tailored and appropriate services and stigma and discrimination. 4 , 5 , 6 , 7 , 8 In addition, the literature on interventions to improve service engagement among adults experiencing homelessness and mental illness is limited. As low levels of engagement are associated with a range of poor outcomes, including greater illness severity, lower quality of life and higher rates of acute care use, 6 , 9 , 10 implementing strategies to improve service engagement of this population remains a priority across healthcare and social service settings.…”