Health Care Cost Analysis of a Frequent User's Program in New York City

Background: The right to housing has been actively enforced by local laws in New York City and supported by Federal Housing policies. Programs providing housing supports for high risk adults with multiple jail stays and homeless shelter experiences can help mitigate the increased risk for HIV and STD's, and for the infected, suboptimal care and access to treatments associated with homelessness.

Methods: We perform a cost-benefit study of the Frequent Users Services Enhancement (FUSE) program, taking into account the averted costs of HIV, other STDs, emergency room use and substance abuse treatment costs. We compare the costs and health care resource utilization rates between our intervention group (n=67) and comparison group (n=90). We use propensity score matching to ensure that comparisons are made between persons with similar socioeconomic and health status. A rigorous sensitivity analysis is conducted to verify the robustness of the results.

Results: Preliminary results demonstrate ‘frequent users' of jail and homeless shelters report behaviors placing them at high risk for HIV and STD infection. Approximately 13% had 3 or more partners in the six months prior to study enrollment, and 42% reported not using a condom during last vaginal or anal intercourse. Participants report an average of 3.5 nights in inpatient care, 3.8 days in detox or residential treatment and 45% had visited the emergency room.

Conclusions: Preliminary results suggest that providing housing and supportive services for formerly incarcerated persons with histories of homelessness can avert significant health care costs and reduce the risk of HIV/STD infection.