Comparing the Utilization and Cost of Health Services between Veterans Experiencing Brief and Ongoing Episodes of Housing Instability

Abstract

Housing instability is associated with costly patterns of health and behavioral health service use. However, little prior research has examined patterns of service use associated with higher costs among those experiencing ongoing housing instability. To address this gap, we compared inpatient and outpatient medical and behavioral health service utilization and costs between veterans experiencing brief and ongoing episodes of housing instability. We used data from a brief screening instrument for homelessness and housing instability that has been implemented throughout the US Department of Veterans Affairs (VA) health care system to identify a national sample of veterans experiencing housing instability. Veterans were classified as experiencing either brief or ongoing housing instability, based on two consecutive responses to the instrument, and we used a series of two-part regression models to conduct adjusted comparisons of costs between veterans experiencing brief and ongoing episodes of housing instability. Among 5794 veterans screening positive for housing instability, 4934 (85%) were experiencing brief and 860 (15%) ongoing instability. The average total annual incremental cost associated with ongoing versus brief episodes of housing instability was estimated at $7573, with the bulk of this difference found in inpatient services. Cost differences resulted more from a higher probability of service use among those experiencing ongoing episodes of housing instability than from higher costs among service users. Our findings suggest that VA programmatic efforts aimed at preventing extended episodes of housing instability could potentially result in substantial cost offsets for the VA health care system.

Costs Associated with Health Care Services Accessed through VA and in the Community through Medicare for Veterans Experiencing Homelessness

“…Finally, Byrne et al. () used data from the universal homelessness screening protocol administered in the VA to distinguish between Veterans experiencing brief and ongoing episodes of housing instability; those whose housing instability was ongoing incurred $7,573 greater VA health care costs than those with brief episodes (Byrne et al. ).…”

“…In this study, they found that homelessness was associated with substantial increases in outpatient encounters, emergency department visits, and inpatient admissions ). Finally, Byrne et al (2017) used data from the universal homelessness screening protocol administered in the VA to distinguish between Veterans experiencing brief and ongoing episodes of housing instability; those whose housing instability was ongoing incurred $7,573 greater VA health care costs than those with brief episodes (Byrne et al 2017). Because this universal screening protocol was introduced in the VA in October 2012, after the timeframe of our study, these data were not available for us to identify Veterans with housing instability.…”

“…Byrne et al. () examined the impact of the duration of homelessness on health care cost and utilization by comparing these outcomes in Veterans who had experienced short‐term vs. long‐term homelessness (Byrne et al. ).…”

“…Despite this increased emphasis on identifying and preventing homelessness within the VA, we know of only one other study estimating the health care cost associated with Veteran homelessness. Byrne et al (2017) examined the impact of the duration of homelessness on health care cost and utilization by comparing these outcomes in Veterans who had experienced short-term vs. long-term homelessness (Byrne et al 2017). Because of this dearth of literature, little information is available to VA providers and policy makers about health care cost and utilization patterns, either within or outside the VA, among Veterans experiencing homelessness.…”

“…() examined the impact of the duration of homelessness on health care cost and utilization by comparing these outcomes in Veterans who had experienced short‐term vs. long‐term homelessness (Byrne et al. ). Because of this dearth of literature, little information is available to VA providers and policy makers about health care cost and utilization patterns, either within or outside the VA, among Veterans experiencing homelessness.…”