Healthcare utilization and needs of homeless youth

Introduction: Homeless youth (HY) are a vulnerable population with a host of healthcare needs.  However, much of the literature concerning HY’s healthcare service utilization and access needs is outdated.  Many factors may affect HY’s access to care, including a lack of: health insurance, identification, and knowledge of where to seek care and how to get there.  We examined rates of health insurance coverage, healthcare utilization, barriers to accessing care, and correlates of unmet need.

Methods: Between May and June 2013, all HY who were accessing services at a drop-in center in Venice, CA were asked to participate.  Seventy percent of the eligible clients completed the self-administered questionnaire (n=125).   

Results:  Most of the HY were male, heterosexual, and white, with a mean age of 21 years.  Only 30% of HY reported having health insurance within the previous 12 months.  Of those who had health insurance, 46% were on their parents’ plan and 34% had Medicaid.  Within the past year, the emergency room was the most frequently cited source of care; emergency care was the most common reason for seeking care, though preventive care was identified by 27% of participants.  Within the past year, 31% of HY had unmet healthcare needs, with financial cost identified as the main barrier.

We examined correlates of healthcare utilization and unmet healthcare needs.  A multivariable logistic regression (n=107) demonstrated that HY with health insurance were 10.8 times (p<0.05) as likely to have used healthcare in the previous year, than those who did not have insurance.  A multinomial multivariable logistic regression (n=98) showed that HY who were currently experiencing major depression were 12.4 times (p<0.01) as likely to report unmet healthcare needs, compared to no needs.  Additionally, HY who identified as Black and non-heterosexual, were 89% and 88% as likely, respectively (p<0.05), to have met healthcare needs, while HY with at least a high school education were over 10 times (p<0.05) as likely to report having met healthcare needs, compared to no needs.  Notably, there was a trend among HY with a history of exchange sex being more likely to report unmet healthcare needs.

Conclusions:  Healthcare service opportunities must be made available to HY.  To increase their comfort with receiving services, previous research identifies the importance of HY having their own time and space for healthcare services.  Future studies should investigate the impact of the Affordable Care Act on HY’s insurance coverage and healthcare service utilization.