The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #58465

Alexander Cowell, PhD, Behavioral Health Economics Program, RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, 919 541 8754, cowell@rti.org, David E. Pollio, PhD, School of Social Work, Washington University, One Brookings Dr., Box 1196, St. Louis, MO 63130-4899, and Carol S. North, MD, MPE, School of Medicine, Washington University, Department of Psychiatry, 660 S Euclid, CB 8134, Renard Building, Room 2210, St. Louis, MO 63110.

Emergency shelters represent a vital resource for the homeless population. In addition to providing beds and meals, a typical emergency shelter may also offer a range of health care services, such as medication management and mental health counseling. Understanding costs of providing these services is critical to appropriate decision-making and cost-effectiveness analyses. While some research has estimated per-client costs at emergency shelters, none estimate the cost per service.

This paper presents cost estimates of thirteen different services provided by six emergency shelters in Saint Louis, Missouri. Data were collected using standardized instruments specifically designed to calculate the economic cost of providing a unit of service.

Results indicate that for some services the cost per unit of service varies considerably across programs. The cost of an hour of life skills counseling, for example, varies from $86 at one shelter to $12 at another. However, for others the cost per unit of service is relatively constant. The cost of an hour of community support, for example, is about $20 across all programs.

The relative influence of three sources for the variation in costs are discussed: a) number and qualifications of staff used to deliver the service; b) wage paid to labor providing the service; and c) overhead and administrative costs. The standardized cost instruments used allow results to be compared across multiple sectors of health care and facilitate a rigorous and complete examination of costs. These advantages in turn allow the creation of effective and efficient service policies for complex populations.

Learning Objectives:

• After this session the participant will be able to:
• i) Articulate the issues and approaches to estimating service costs for an emergency shelter.
• ii) Discuss the differences in costs across programs, and the reasons for these differences.
• iii) Utilize the information from these results to shape service policy for the homeless population.

Keywords: Cost Issues, Homeless Health Care

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: NIDA - grant RTI - employer