Medical Education Symposium

First Author Information

Christopher Brown, MS, Medical Student, VCU School of Medicine
Colin Reinhart, MS, Graduate Student, Eastern Virginia Medical School

Additional Author(s) Information

Aarshati Shah, BS, Masters of Public Health Student, School of Health Professions, EVMS

Brian Martin, PhD MBA, Associate Professor, Program Director, MPH Program, EVMS

Paul Aravich, PhD, Physical Medicine and Rehabilitation; Pathology and Anatomy; Internal Medicine, Division Geriatrics, EVMS

James Etheridge, MS, Medical Student, Eastern Virginia Medical School

Presentation Format

Poster

Type of Activity

Innovation

Original Presentation Date

2017

Date of Submission

May 2017

Abstract/Short Description

Introduction: Homeless individuals bear a disproportionately high burden of disease. Lack of health insurance amongst homeless populations is a significant barrier to healthcare access.

Methods: This study explored barriers and facilitators to health insurance via a survey-format that focused predominantly on attitudes towards health insurance and enrollment assistance.

Results: Majority of respondents endorse a facilitator to guide the enrollment process at their location of healthcare. While 43.8% of participants reported they knew where to go for enrollment assistance, 43.7% did not. 100% of participants agreed that health insurance is important, while only 43.1% were insured.

Conclusion: Distrust regarding facilitation in the previous literature is overstated. Confusion during enrollment process is a merited concern. Data from this study showed that the population prioritizes health insurance. Financial barriers remain significant. This population has overall positive attitude towards health insurance enrollment and facilitation. Low-level outreach is warranted.

Purpose/Research Question

The purpose of this study was to evaluate and explore barriers and facilitators to health insurance amongst an urban homeless population; focusing predominantly on attitudes towards health insurance and enrollment assistance that may inform future enrollment efforts.

Objectives

To identify barriers to health insurance enrollment amongst homeless individuals.

To identify efficacy of facilitators to health insurance enrollment amongst homeless individuals.

To identify efficacy of facilitator placement for health insurance enrollment.

To gauge receptiveness of homeless individuals in receiving assistance navigating the health insurance enrollment process.

References

"1. Meghan Henry RW, Lily Rosenthal, and Azim Shivji, Abt Associates. The 2016 Annual Homeless Assessment Report (AHAR) to Congress. The U.S. Department of

2. Morrison DS. Homelessness as an independent risk factor for mortality: results from a retrospective cohort study. Int J Epidemiol. 2009;38(3):877-883.

3. Jezewski MA. Staying connected: the core of facilitating health care for homeless persons. Public Health Nurs. 1995;12(3):203-210.

4. Fryling LR, Mazanec P, Rodriguez RM. Barriers to Homeless Persons Acquiring Health Insurance Through the Affordable Care Act. J Emerg Med. 2015;49(5):755-762.e752.

5. DiPietro B KS, Ertiga D, et al. Medicaid Coverage and Care for the Homeless Population: Key Lessons to Consider for the 2014 Medicaid Expansion. W A S H I N G T O N , D C: The Henry J. Kaiser Family Foundation; September 2012.

6. Kushel MB, Vittinghoff E, Haas JS. Factors associated with the health care utilization of homeless persons. JAMA. 2001;285(2):200-206.

7. Riley ED, Moore KL, Haber S, Neilands TB, Cohen J, Kral AH. Population-level effects of uninterrupted health insurance on services use among HIV-positive unstably housed adults. AIDS Care. 2011;23(7):822-830.

8. Baicker K, Taubman SL, Allen HL, et al. The Oregon experiment--effects of Medicaid on clinical outcomes. N Engl J Med. 2013;368(18):1713-1722.

9. O'Toole TP, Johnson EE, Borgia ML, Rose J. Tailoring Outreach Efforts to Increase Primary Care Use Among Homeless Veterans: Results of a Randomized Controlled Trial. J Gen Intern Med. 2015;30(7):886-898.

10. Courtemanche C, Marton J, Ukert B, Yelowitz A, Zapata D. Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States. 2016. doi:10.3386/w22182.

11. Tsai J, Rosenheck RA, Culhane DP, Artiga S. Medicaid expansion: chronically homeless adults will need targeted enrollment and access to a broad range of services. Health Aff (Millwood). 2013;32(9):1552-1559.

12. Chwastiak L, Tsai J, Rosenheck R. Impact of health insurance status and a diagnosis of serious mental illness on whether chronically homeless individuals engage in primary care. Am J Public Health. 2012;102(12):e83-89."

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VCU Medical Education Symposium

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