HOMELESS: Contribute Disproportionately To Hosp. Costs
Care for homeless patients is putting heavy financial pressure on hospitals that care for them. Homeless patients cost the facilities $2,400 more per admission than other low-income patients and have lengths-of-stays that are on average 4.1 days longer. "One group of psychiatric patients had stays averaging 70 days more than medical treatment called for because clinicians believed they couldn't be safely discharged," the Wall Street Journal reports. The "provocative new study," published in today's issue of the New England Journal of Medicine, is the "first large scale study to actually document the economic impact of homelessness on the health care system" (Winslow, 6/11).
The study found that nearly three-quarters of the patients studied were "hospitalized for conditions for which hospitalization is often preventable, including substance abuse, mental illness, respiratory disorders, trauma, skin disorders and infectious diseases other than AIDS." The bulk of the additional days of hospitalization were accounted for by psychiatric (57%) and AIDS (12%) patients. Homeless patients admitted for psychiatric problems cost hospitals $4,094 more than other low-income patients, and homeless AIDS patients cost $3,370 more. The "leading cause of long stays ... was placement problems among homeless psychiatric patients." Doctors also said they delayed discharge for many homeless patients because they knew the patients would not have access to adequate follow-up care or sanitary living conditions, and lowered the admission bar for others "whose medical conditions [were] likely to worsen if they remain in shelters or on the streets" (Salit, et al, 6/11 issue). Click here to see an abstract of the study.
Pay Now Or Pay Later
The study, funded by the United Hospital Fund of New York, examined the cost of care for homeless patients admitted to public hospitals in New York City in 1992 and 1993. United Hospital Fund health policy analyst Sharon Salit, the lead author of the study, said, "The homeless account for less than one-half of one percent of the city's population, but they are having a huge impact on the health care system." She added, "The extra costs for a single hospital admission are as much as the annual welfare rental allowance for a single individual in New York." The study found that 80% of the costs of care for the homeless patients were paid for by Medicaid. The Journal reports that the findings of the study "illustrate the impact of addressing the consequences instead of the causes of some of the nation's social ills" (6/11).
Swimming Against The Current
An accompanying editorial in the NEJM by Princeton University's Dr. Paul Starr notes: "Failure to deal with a social problem 'upstream' (lack of housing, education, health insurance, substance-abuse prevention) leads to added costs 'downstream' (police, prisons, hospital care)." Starr writes that "downstream" institutions like hospitals and prisons are both expensive and ill-equipped to provide the necessary fix for the problem of homelessness. He notes that "attacking the problem upstream would be both more efficient and more effective," and that "we continue paying to put the homeless in hospital beds while not providing them with ordinary beds of their own" (Starr, 6/11 issue). The Journal reports that other advocates for the homeless have echoed Starr's assertion, stressing the need to increase "investment in housing programs to save money now spent ... for health care" (6/11). Salit and the study's other authors concluded that more spending on "upstream" programs "represent[s] a more cost-effective as well as a more humane approach to the problem of homelessness" (NEJM, 6/11).
Trying It In Minnesota
Minnesota is experimenting with the improvement of "upstream" programs with a plan "that invested money in supportive housing for 180 homeless and disabled persons." A report for the New York-based Corporation for Supportive Housing shows that the program "saved the state $9,600 per person in funds that would otherwise have been spent on health care, jails and other services." Corporation President Julie Sandorf said: "If you don't look at housing, health care and other social services as a seamless web, you will get a constant recycling of homeless folks through very-high-cost hospital and other institutional care" (Journal, 6/11).