HKS Student Explores Healthcare Access for Those Who Need it Most

January 9, 2012
By Sara Steinmetz, Women and Public Policy Program

Recent changes to healthcare coverage will require all health insurance providers to completely cover the cost of contraceptives for patients (including removing co-pays or other fees) by January 2013. This measure is part of an effort to remove cost as a barrier to women’s access to birth control, preventative care services including prenatal care, screening for STDs, and counseling and equipment to encourage breast feeding.

Although the new legislation will facilitate access to health care for many women, one group with particularly high need is unlikely to benefit, low-income and homeless women. This past summer the Women and Public Policy Program(WAPPP), with support from the Roy Family Fellowship, enabled a Harvard Kennedy School student to analyze the specific issues resulting from this gap in coverage and access. Emily Polak, a second-year MPP student, conducted a survey for the Seattle Women’s Commission evaluating access to healthcare for women living in Seattle’s Tent City 3 and for those in longer-term shelters.

Polak found that access to many services – including mental and women’s healthcare, vision and dental care, and prescription drugs – is lacking. Co-pay and other fees are too high for residents. Even sliding-scale fees are too high for someone without a regular income. Many clinics will not accept patients who cannot afford to pay, and others impose long wait periods on new patients without insurance. Residents often fear they will not be treated if they cannot provide an address to healthcare providers. Furthermore, information on health centers and access to bus routes that service medical clinics, hospitals, and social services offices is also limited, further impacting the accessibility of preventative care. Many patients instead elect to visit the ER for healthcare needs, effectively using the ER as a primary care physician since the ER is required to provide treatment.

As part of her project, Polak spent time tracking down and later compiling a set of resources to share with residents to help support their health care needs. This guide included information on free vision exams and glasses, free dental care including dentures, and free prenatal care. This resource manual will be especially helpful to Tent City 3 residents who have limited access to telephones, the internet, or other sources of information on clinics and health services, and should hopefully provide an alternative to ER visits for obtaining health care. She also produced a report with key findings, demographical data, and other information from her interviews, and plans to build upon this work for analyses of healthcare accessibility for homeless in other cities.

Seattle’s Tent City

These are the piles of people's belongings, ready to be loaded onto moving trucks.

"Residents of Tent City 3 are required to relocate every 90 days, meaning further barriers to accessing health care since many host sites are far from the downtown clinics," said Polak.

Emily Polak in Tent City

Emily Polak in Tent City 3.

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