Health Care Services for the Homeless

The evolution of nurse managed clinics and the development of a major homelessness problem are coincidental phenomena in the contemporary United States. Factors as diverse as public finding constraints, shortages of physicians in the nation's inner cities and rural areas, and the increasing trend toward physician specialization are creating an interaction between these phenomena.

Homelessness in the United States developed into a major social problem during the 1980s. Both the number and the demographic composition of the homeless in the United States, however, are matters of dispute. Such disagreements occur for reasons of both societal structure and political motivation. First, consider the number of the homeless. The National Coalition for the Homeless, an advocacy group, states that approximately three million persons in the United States will be homeless at some point during any given 12-month time period (Ehrlich, 1988, p. 132). By contrast, the United States Department of Housing and Urban Development in the Bush era estimated that, at any given point in time, the homeless number between 250 and 400 thousand.

Counting the homeless is, at best, a difficult undertaking. The homeless are not congregated in easily found locations. Further, locations are often fluidùthe individual who sleeps under one freeway overpass tonight may sleep under another tomorrow, and

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in Portland, Oregon (Magnet, 1987, p. 172). On the average, then, minority racial and ethnic groups are represented among the homeless at about 2.25 times their representation in the general population, which means that almost 45 percent of the nation's homeless are members of minority racial and ethnic groups. Health Care For the Homeless Problems of numbers of persons, their locations, their characteristics, and their distrust of the system make the delivery of health care services to the homeless difficult. Further, it is not just the homeless, but rather all indigent persons who must be provided community health care services. As costs associated with the delivery of health care services soared in the 1980s and continue to increase in the 1990s, third party funders, health care providers, and users of health care services sought to develop and implement procedures and programs which would either stabilize costs or reduce the rate of increase. Health care services funded by government received special scrutiny. None of the approaches thus far attempted has proven to be particularly successful. Approximately 60 percent of the American population is covered by private health care insurance programs (Congressional Budget
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Approximate Word count = 2338
Approximate Pages = 9 (250 words per page)

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