Sick and unsheltered: Homelessness as a major risk factor for emergency care utilization

Health Care Spending And Use Among People Experiencing Unstable Housing In The Era Of Accountable Care Organizations

“…26 To our knowledge, this is the first study to provide a detailed analysis of health care spending and use based on longitudinal claims data in a continuously enrolled population whose members experienced episodes of homelessness, compared to a general population of Medicaid enrollees with no evidence of experiencing homelessness. Our unadjusted results were consistent with previous studies' findings of high rates of inpatient, outpatient, and emergency department visits among the homeless population, [5][6][7][8][9][10][11][12][13][14][15][16][17] though most previous studies did not have the granularity to look at the other types of services (such as specialty visits, procedures, imaging, and tests) that we examined. The association between homelessness and intensive health care use is thought to be due both to the high burden of co-occurring medical, psychiatric, and substance use disorders and to social factors such as challenges with health literacy, difficulty adhering to medication regimens, lack of transportation, lack of child care, perceived discrimination in health care settings, and cognitive impairment.…”

“…Previous studies have noted a high rate of health care use, particularly emergency department and inpatient visits, among the homeless population in the US-even those who are insured. [5][6][7][8][9][10][11][12][13][14][15][16][17] However, while providing valuable groundwork, the literature has been largely cross-sectional, [5][6][7][8][9][10][11][12][13][14][15][16] based on self-reported data on health care use, 8,9,11,[13][14][15][16] and not comprehensive. [8][9][10][11][12][13][14] Moreover, many of these studies focused on care delivered at a single clinical site or practice.…”

“…[8][9][10][11][12][13][14] Moreover, many of these studies focused on care delivered at a single clinical site or practice. 10,14,15,17 Many lacked a comparison group, 5,9,10,13,15 and few had data on health care spending in addition to use. 5,[7][8][9][11][12][13][14][15][16][17] Finally, most of these studies were based on data from the period before the Affordable Care Act, when ACO contracts were less prevalent.…”

“…10,14,15,17 Many lacked a comparison group, 5,9,10,13,15 and few had data on health care spending in addition to use. 5,[7][8][9][11][12][13][14][15][16][17] Finally, most of these studies were based on data from the period before the Affordable Care Act, when ACO contracts were less prevalent. [5][6][7][9][10][11][12][13][14][15][16] This study examined Medicaid claims data across three years in a continuously enrolled population cared for by the Boston Health Care for the Homeless Program (BHCHP) in the Massachusetts Medicaid Primary Care Payment Reform Initiative (a value-based payment program that was a precursor to the state's Medicaid ACO program).…”

Homelessness and Health: A Retrospective Analysis of Medical Records From 2006 - 2020 to Explore the Health and Social Situation of Homeless People in Berlin. A Study Protocol

“…Rough sleepers are less likely to be registered with a general practitioner (37) and often do not have access to preventive care such as routine check-ups (38,39). The consequence of this lack of access to primary care results in a higher number of emergency department visits, hospital (re)admissions and longer inpatient stays (36,40,41).This aspect is also re ected by the high use of emergency departments for dental problems by homeless people (42,43).…”