Factors associated with frequent emergency department visits and hospitalizations among homeless people with Medicaid: Implications for health care reforms
Methods: We identified 6,494 individuals from merged Boston Health Care for the Homeless Program (BHCHP) and Medicaid datasets in CY 2010. Variables examined included demographics, housing status, mental illness/substance use disorder (SUD) groups, and selected physical conditions. We used negative binomial regression to examine hospitalizations and ED visits because they are count data with over-dispersion.
Results: On average, homeless individuals had one hospitalization and four ED visits in CY2010. Multivariable analyses showed that homeless individuals with co-occurring mental illness and SUDs were at the greatest risk of frequent hospitalizations and ED visits (e.g., incidence rate ratio (IRR)=3.1 to 15.3 for hospitalizations) followed by those with schizophrenia or SUD alone. Most selected physical conditions were moderately associated with increased utilization (IRR=1.1 to 2.3). Additionally, unhoused individuals had significantly higher utilization than those who had supported housing (e.g., IRR=1.5 for hospitalizations among those lived on the street).
Conclusions: Homeless individuals experienced heavy inpatient and ED use, particularly those without stable housing and those with co-occurring mental illness and SUDs. States could consider provisions under the Affordable Care Act, e.g., Medicaid expansion and Health Homes, jointly with supportive housing to meet the needs of homeless individuals which may improve the quality and cost-effectiveness of care.
Learning Areas:Other professions or practice related to public health
Provision of health care to the public
Public health or related public policy
Public health or related research
Describe health care utilization among homeless individuals with Medicaid Examine factors associated with frequent hospitalizations and emergency department visits Formulate care and services strategies by leveraging provisions under the ACA
Keyword(s): Homelessness, Health Care Reform
Qualified on the content I am responsible for because: I have been the principal and co-investigator of multiple federally and state funded grants/projects on health care delivery and financing and program evaluation for publicly insured population. Among my research interests, homeless population is one of the vulnerable populations that I'd like to improve the care delivery.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.