Utilization of Medical Care for Unhoused Individuals in the Los Angeles Skid Row Community
Bhullar, S., Elhaija, A.
Affiliation: University of California, Los Angeles (UCLA)
Published: July 2025
DOI: https://doi.org/10.58417/VHUU6337
Abstract: Skid Row in downtown Los Angeles is home to one of the nation’s largest concentrations of unhoused individuals, with approximately 3,800 people experiencing homelessness as of 2024, around 70% of whom are unsheltered (1). This community faces significant challenges in accessing and utilizing medical care, resulting in fragmented and episodic treatment. A 2023 study reported that homeless individuals in California made over 650,000 emergency department (ED) visits between 2019 and 2020, representing about 3% of all hospital encounters in California (2). This reliance on emergency services is often due to the lack of consistent primary care access; other contributing factors include transportation issues, lack of insurance, and discrimination in healthcare settings (3). Mental health and substance use disorders further complicate healthcare utilization. A statewide study found that 45% of homeless adults described their health as “poor or fair”, and 60% reported having a chronic disease (2). Despite these health challenges, many lack access to consistent primary care, leading to ED usage for conditions manageable in outpatient settings (4). These patterns are reflected locally in Los Angeles’ Skid Row. In a 2023 study, 78% of surveyed individuals reported having health insurance — most commonly MediCal — yet 75.7% expressed interest in accessing additional health screenings (5). This discrepancy between insurance coverage and preventive care utilization highlights systemic barriers even when basic coverage exists. Barriers to accessing care are multifaceted. A 2021 review identified obstacles such as lack of insurance, transportation, and healthcare discrimination, which deter homeless individuals from seeking treatment (3). These factors contribute to underutilization of available services, even when present in the community (6). In conclusion, the utilization of medical care among unhoused individuals in Skid Row is hindered by a combination of systemic barriers, including limited access to regular providers, high reliance on emergency services, and significant unmet needs in mental health and substance use treatment. Addressing these challenges requires targeted interventions to improve access to consistent, comprehensive, and integrated healthcare services for this vulnerable population.
Works Cited
1. “Skid Row.” Homeless Initiative, County of Los Angeles, 20 Mar. 2025, homeless.lacounty.gov/skidrow/. Accessed 19 May 2025.
2. Kushel, Margot, and Tiana Moore. Toward a New Understanding: The California Statewide Study of People Experiencing Homelessness, UCSF Benioff Homelessness and Housing Initiative, June 2023, homelessness.ucsf.edu/sites/default/files/2023-06/CASPEH_Report_62023.pdf.
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4. Ward, Jason. Study of Unhoused People in Three Key Los Angeles Communities Finds Numbers Did Not Grow; Population’s Needs Remain High | Rand, RAND, 2 July 2024, www.rand.org/news/press/2024/07/02.html. Accessed 19 May 2025.
5. Elhaija, Ahmad, et al. “Identifying the Service Needs of Homeless Individuals in the Skid-Row Community.” Journal of Social Distress and Homelessness, vol. 33, no. 1, 10 Mar. 2023, pp. 258–262, doi:10.1080/10530789.2023.2187273.
6. Feldman, Brett J., et al. “From the Hospital to the Streets: Bringing Care to the Unsheltered Homeless in Los Angeles.” Healthcare, vol. 9, no. 3, Sept. 2021, p. 100557, doi:10.1016/j.hjdsi.2021.100557.