Homeless people are concentrated in the nation's urban centers and are dispersed throughout rural America, not often close to the health care facilities that they need. They don't have transportation or real control over their daily lives, since they depend on the routines of shelters, soup kitchens and marginal jobs to meet their most basic survival needs. Finding health care is tough or impossible. For many homeless people, seeking health care takes a back seat to more immediate priorities for survival. For some, the symptoms of their illnesses or bad experiences with the health care system in their past cause them to actually avoid health care.
Unacceptable costs result from poor access to health care.
Ultimately, as relatively minor problems develop into health care emergencies, most homeless people do get treated, but it is treatment of the most expensive sort, delivered in hospital emergency rooms and acute care wards. Through taxpayer support of public institutions and through the cost-shifting inherent in the health insurance system, we all pay the high costs of care deferred. Undetected and untreated communicable diseases threaten the health of other homeless people in particular and of the public generally, and the bill increases as disease spreads. In the long run, perhaps the greatest costs are the moral and social results of neglecting the needs of dispossessed, seriously ill people in our midst. A sensible and effective response to the health needs of homeless people has developed over the past ten years.