An interview study of 162 homeless individuals on O'ahu demonstrated that the homeless studied were 3 times more likely than the general population of O'ahu to rate their health as fair to poor, despite the fact that 77% of interviewees had medical insurance and 66% a regular health care provider Better self ratings of health were only associated with younger age and self report of having dental insurance when demographic variables were controlled for. Qualitatively the homeless population interviewed described 'good health' as avoiding illness and being able to make healthy lifestyle choices, finding emotional balance and caring for others. Commonly reported barriers to accessing care included financial factors such as being unable to purchase medications; environmental challenges such as clean drinking water and a safe place to stay; and general discomfort with the health care system. Clinical implications of this study indicate the need for providers caring for the homeless be alert to challenges particular to the homeless, such as barriers to following medical advice (high fiber/low salt diet, exercise, refrigerating medications, etc.). The surprising relationship between knowledge of having dental insurance and better self ratings of health deserves additional research, as does the lack of association between health ratings and having health insurance and a regular provider.