Homeless patients cost about $2,500 more per hospital stay than the average patient, according to a new study by researchers at St. Michael's Hospital.
Homeless people with medical or surgical problems arrive at the hospital with underlying health issues and stay longer than others, often because there is no place to send them after their initial medical crisis has been treated, the study found. Those with psychiatric illness arrive at the hospital much sicker than others.
The findings suggest the cost of hospitalizing people who are homeless "has a substantial impact on the health care system," said Dr. Stephen Hwang, the lead author of the study and a research scientist with the hospital's Center for Research on Inner City Health.
The study appears in the March issue of Medical Care, a journal of the American Public Health Association.
Hwang analyzed data for 90,345 housed patients and 3,081 homeless patients admitted over five years to St. Michael's, a 500-bed hospital in downtown Toronto that accounts for about one-quarter of all hospitalizations of homeless people in the city.
After adjusting for age, sex, and the severity of the illness, a hospital stay for patients who were homeless cost $2,559 more than patients who were housed. Hwang's past research has shown that hospitalizations are common in this disadvantaged population: In one year, 100 homeless people will have about 23 hospitalizations, compared to only five hospitalizations among 100 people in the general population. The average cost of a hospital stay among patients in the study was $13,500.
Hwang found that homeless people with medical or surgical problems often stay in hospital after they no longer need acute care because they are awaiting discharge to another health care institution such as rehabilitation or long-term care facility, or because they are not well enough to return to a shelter or the shelter is unable to receive them.
Previous studies have found respite facilities -- also known as infirmaries -- are an effective and less expensive alternative to keeping homeless patients in the hospital. In contrast to traditional shelters, infirmaries do not require homeless people to leave each morning and they provide nursing and medical care. There is only one infirmary facility open to all homeless men and women in Toronto, at the Sherbourne Health Centre. A second infirmary at Seaton House accepts primarily men who were living at Seaton House prior to their hospitalization.
The higher costs for hospitalizing homeless people with psychiatric problems is probably due to the severity of their illness when they are admitted, Hwang said. This could reflect both the limited availability of mental health services for the homeless in the community and the necessity to have severe symptoms to be hospitalized.
"Assertive outreach through community mental health programs may lower costs by preventing or reducing the duration of psychiatric hospitalizations among homeless people," he said.
James Weaver, a co-author of the study, noted that the extra $2,500 for hospitalizing a homeless person is almost exactly the same figure as that found in the only other study on the topic, conducted in New York City in 1998.
"The fact that excess hospitalization costs for homeless people were observed in this study conducted in Canada shows that these higher costs are not eliminated by the presence of universal health insurance," he said.
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