Among people facing homelessness, a small group has a very high number of encounters with the health care system

Hwang SW, Chambers C, Chiu S, Katic M, Kiss A, Redelmeier DA, Levinson W. A Comprehensive Assessment of Health Care Utilization among Homeless Adults under a System of Universal Health Insurance. American Journal of Public Health. 2013; 103 (S2): S294-S301.

Issue: People facing homelessness experience high rates of physical and mental health problems and traumatic injuries compared to the general population. At the same time, people facing homelessness frequently do not have access to the conditions necessary to get and stay better including stable housing, healthy food and adequate privacy. Finally, many encounter barriers to access for primary or preventative health care, and are often forced to seek care in hospitals and/or emergency rooms.

What we did: We looked at health records from 2004/5 – 2009 for 1,165 adults using homeless shelters and meal programs in Toronto to assess patterns of health care use.

Findings: People experiencing homelessness were in more frequent contact with health care services than Toronto residents living in neighbourhoods with low household incomes. We also found a small group of people facing homelessness with very high health care needs over the study period.

– When compared to people of the same age and sex living in neighbourhoods with low household incomes in Toronto, people facing homelessness were:

  • 8.5 times more likely to visit the emergency department;
  • 4 times more likely to be hospitalized for medical issues or surgery;
  • 9 times more likely to experience a psychiatric hospitalization.

– When we just looked at people facing homelessness, we found that 10% of those surveyed were high utilizers of health care services and accounted for:

  • 60% of all emergency department visits among people facing homelessness;
  • 80% of all hospitalizations for medical issues or surgery among people facing homelessness;
  • 86% of all psychiatric hospitalizations among people facing homelessness.

Policy and program implications:

– Efforts to reduce frequent encounters with emergency departments and hospitals among people facing homelessness will require sustained efforts to improve supports available for the long-term management of physical and mental health problems and address structural issues such as lack of affordable housing.

– Programs and supports focused on reaching people with high health care use have the potential to make a substantial impact on the health of individuals and on the overall health care system.

Read full text here.

Two companion papers were also printed in the American Journal of Public Health ‘Homelessness and Public Health’ supplement in December 2013.

Chambers C, Katic M, Chiu S, Redelmeier DA, Levinson W, Kiss A, Hwang SW. Predictors of Medical/surgical and Psychiatric Hospitalizations among a Population-based Cohort of Homeless Adults.

Chambers C, Chiu S, Katic M, Kiss A, Redelmeier DA, Levinson W, Hwang SW. High utilizers of emergency health services in a population-based sample of homeless adults.

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