Health Care–Seeking Behavior Among Homeless Individuals Under Universal Health Coverage in Taiwan: A Health Belief Model Perspective

Despite Taiwan’s universal National Health Insurance (NHI), homeless individuals may face a proposed “coverage paradox” in which legal entitlement to care may not guarantee actual health care engagement. This study applied the Health Belief Model (HBM) to investigate self-reported health care engagement propensity in this population. We conducted face-to-face interviews with 124 randomly sampled homeless individuals in Northern Taiwan. Hierarchical regression analysis was performed to compare the predictive power of sociodemographic variables against HBM constructs. While sociodemographic variables explained 19% of the variance in the initial model, the inclusion of HBM constructs significantly increased the total explanatory power to 41.0%. Perceived susceptibility (β = 0.38) and perceived severity (β = 0.34) emerged as the strongest predictors, surpassing self-efficacy (β = 0.20). Conversely, perceived barriers (β = −0.23) remained a significant negative predictor despite universal coverage. The primary bottleneck to care is not merely a lack of confidence but a low perception of health threat due to the normalization of poor health conditions. We recommend a 2-pronged strategy: implementing street-based health screenings to enhance risk awareness and deploying health navigators to overcome non-financial barriers.