Why Do Homeless People Use a Mobile Health Unit in a Country With Universal Health Care?

Abstract

Mobile health units (MHUs) are an important source of health care for the uninsured; however, it is unclear what role these units play in Canada, where a universal health insurance system exists. The purpose of this study was to understand why individuals who live in a country with universal health insurance seek care at an MHU and to determine whether MHUs are used in addition to or in place of the client's usual source of care. This study investigated the use of the Rotary Club of Toronto Health Bus among 150 homeless and marginally housed adults in Toronto, Ontario, over a 3-month period. Data were collected on demographic characteristics, current and lifetime homelessness, health care use, and reasons for using the Health Bus. The majority of participants (94.6%) had a regular health care source, primarily doctor's offices (41.6%) and community health centers (16.1%); 18 (12.1%) stated that the Health Bus was their usual source of care. Participants were frequent users of the Health Bus, reporting a median of 7.0 visits (interquartile range, 3.5-12.0 visits) in the past 3 months. Most clients (86.0%) reported using the Health Bus to obtain basic supplies (eg, vitamins, socks); health problems were cited as reasons for using the Health Bus for 55 (36.7%) participants. The findings suggest that in a country with universal health insurance, MHUs supplement other sources of health care, providing essential supplies and offering important outreach services to a high-needs population.

Tailoring Outreach Efforts to Increase Primary Care Use Among Homeless Veterans: Results of a Randomized Controlled Trial

“…It is important to note that the intervention studied in this paper consisted of a single outreach event that is distinct from several current outreach activities that include mobile clinics, Bstreet^teams, etc. 25,26 While significant outcomes were identified with this more minimal process, we presume that there is a Bdose effect,' where more robust results would occur with a more longitudinal or intensive approach.…”

Homeless persons' experiences of health‐ and social care: A systematic integrative review

“…Twenty‐two studies relevant to our aim and research questions were included in the review, 11 quantitative (Asmoredjo, Beijersbergen, & Wolf, ; Baggett, O'Connell, Singer, & Rigotti, ; Hwang et al, ; Jenkins & Parylo, ; Kertesz et al, ; van Laere, de Wit, & Klazinga, ; Robbins, Wenger, Lorvick, Shiboski, & Kral, ; Uddin et al, ; Vuillermoz, Vandentorren, Brondeel, & Chauvin, ; Whelan et al, ; Zur & Jones, ), and 11 qualitative (Biederman, Gamble, Manson, & Taylor, ; Biederman, Nichols, & Lindsey, ; Bungay, ; Corrigan, Pickett, Kraus, Burks, & Schmidt, ; Gültekin, Brush, Baiardi, Kirk, & VanMaldeghem, ; Kryda & Compton, ; Martins, ; McLeod & Walsh, ; Nickasch & Marnocha, ; Rae & Rees, ; Voronka et al, ). We found no studies that described economic costs in conjunction with needs of health‐ and social care in persons experiencing homelessness.…”

Accessibility and utilization patterns of a mobile medical clinic among vulnerable populations

“…As such, they are frequently regarded as venues of convenience, delivering healthcare at the doorstep of communities that are otherwise limited by location (Leese et al 1993, Sarnquist et al 2011), cost (Edgerley et al 2007), insurance status (Edgerley et al 2007, Heller and Goldwater 2004), diverse language (Guruge et al 2010), stigma (Whelan C 2010, Daiski 2005), or other structural barriers such as proximity and access to transportation (Hastings et al 2007, Shannon et al 2008, Collinson and Ward 2010). …”

“…MMCs have been especially successful in addressing the geographical extremes of both rural (Peritogiannis et al 2011, Sarnquist et al 2011) and urban poor (Daiski 2005), where accessibility to fixed healthcare is limited due to the dearth of facilities and meager financial resources. They are also advantageous in meeting the needs of medically vulnerable populations that often experience erratic or limited healthcare in traditional settings due to underlying mental illness (Chiu and Primeau 1991), unstable housing (Collinson and Ward 2010, Amarasingham et al 2001, Whelan C 2010), poverty, migration status (Collinson and Ward 2010, Guruge et al 2010, Simsek et al 2012), substance use (Thompson et al 1998), or other stigmatized behaviors such as sex work (Shannon et al 2008). MMCs therefore innovatively increase healthcare accessibility and reduce health disparities for communities marginalized by geographic, social, and structural barriers through delivering essential services for preventative (Jit et al 2011, Collinson and Ward 2010, Morano et al 2013b, Schwarz et al 2009, Vyas et al 2011), primary care (Leese et al 1993, Daiski 2005, Simsek et al 2012, Hastings et al 2007, Pollack et al 2002), and disease-specific care (Sarnquist et al 2011, Maheswaran et al 2012, Ruiz and Briones-Chavez 2010, Liebman et al 2002, Ruiz et al 1973, Massie 1972).…”