Factors associated with access to care and healthcare utilisation in the homeless population of England

Timothy Elwell-Sutton, Jonathan Fok, Francesca Albanese, Helen Mathie, Richard Holland

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Introduction: People experiencing homelessness are known to have complex health needs which are often compounded by poor access to healthcare. This study investigates the individual-level factors associated with access to care and healthcare utilisation among homeless people in England.

Methods: A cross-sectional sample of 2,505 homeless people from 19 areas of England was used to investigate associations with access to care and healthcare utilisation.

Results: Rough sleepers were much less likely to be registered with a GP (OR 0.45, CI 0.30-0.66) than single homeless in accommodation (reference group) or the hidden homeless (OR 1.48 CI 0.88-2.50). Those who had recently been refused registration by a GP or dentist also had lower odds of being admitted to hospital (OR 0.67, CI 0.49-0.91) or using an ambulance (OR 0.73, CI 0.54-0.99).

Conclusions: The most vulnerable homeless people appear to face the greatest barriers to utilising healthcare. Rough sleepers have particularly low rates of GP registration and this appears to have a knock-on effect on admission to hospital. Improving primary care access for the homeless population could ensure that some of the most vulnerable people in society are able to access vital services which they are currently missing out on.
Original languageEnglish
Pages (from-to)26-33
Number of pages8
JournalJournal of Public Health
Issue number1
Early online date18 Feb 2016
Publication statusPublished - Mar 2017


  • health services
  • primary care
  • social determinants

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