This week we will be discussing an article published in August 2020 in the Journal of Student-Run Clinics. In this article, titled “Emergency Department Use and Barriers to Healthcare Among Homeless and Uninsured Patients at a Student-Run Free Clinic”, authors Bhathena, Moczygemba, and Lawson assess barriers to healthcare experienced by a small sample of uninsured and homeless patients accessing a student-run, free healthcare clinic in Texas. 


Why did they do it?

For a variety of reasons, accessing healthcare is a tremendous challenge for low income individuals/families. Even amidst the presence of a handful of healthcare programs that primarily serve uninsured and/or homeless patients, these individuals can still often spend months on waiting lists prior to securing an appointment. As a quicker/more accessible solution, many uninsured/homeless patients turn to emergency departments (ED) for care. Unfortunately, these options are often costly and present with additional barriers such as overcrowding and lack of continuity of care. 

Thus, with an aim to design new resources and improve existing resources that help homeless and low income individuals gain healthcare access, the authors of this study present three primary objectives:

  1. Identify barriers to healthcare experienced by uninsured and homeless patients
  2. Assess patient perceptions of helpfulness of social service resources
  3. Examine the relationships between treatment barriers, emergency department use, and health status


How did they do it?

The authors administered a survey to patients who were accessing a student-run, free clinic in Travis County, Texas between February 2017 and November 2017. The survey included 40 questions assessing demographic information, current means of accessing healthcare, reported hospital and ED usage, self-rated health status, and perceived barriers to healthcare. 


What did they find?

In total, 48 surveys were completed. The majority of participants (57%) earned <$10,000/year, and most commonly reported housing as a shelter, transitional living facility, or the street. The most common health insurance was a local medical assistance program (50%), followed by no coverage at all (29%). 

The most common barriers to healthcare reported in this study were cost, lack of transportation, and lack of insurance. The authors also found a significant relationship between lack of transportation and reported emergency department use, suggesting that reliable transportation is a critical component for patients to attend and receive healthcare and social services. Additionally, a significant association between utilization of a local mental health services program and reported emergency department usage was also found. As the authors highlight, a large proportion of annual emergency department visits in the United States involve mental and substance use disorders. 


What does it all mean (our take)?

This study, though consisting of data gathered from a small sample of individuals, provides really nice information pertaining to healthcare treatment barriers in a highly vulnerable population. We applaud the authors for conducting this work and believe that it contributes mightily to the continued efforts in improving healthcare accessibility for low income/homeless populations. 

The apparent relationships between tangible products (e.g., transportation) and ED visits, as well as mental health difficulties and ED visits, clearly demonstrates that creating an ecosystem of support that covers a variety of different domains may be most beneficial for low income/homeless populations. Further, given one of the outcomes of an improved network of available services could be reduced ED visits,  investing in these types of support programs may actually drive the cost of overall healthcare for low income populations down. Here we are presented with the opportunity for a win-win - better healthcare and thus better health for low income/homeless individuals, and simultaneously lower overall costs. 

Again, we appreciate the author’s work on this study, and we are hopeful that information like this will be used in developing more comprehensive services to assist those in need.

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