142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Health service utilization for homeless and low-income persons: A spotlight on the VA Supportive Housing (VASH) program in Los Angeles

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Sonya Gabrielian, MD, MPH , Psychiatry, West Los Angeles VA / UCLA, Los Angeles, CA
Anita Yuan, PhD, MPH , VA Greater Los Angeles
Ronald M. Andersen, PhD , Department of Health Services, UCLA School of Public Health, Los Angeles, CA
Lisa Rubenstein, MD, MSPH , Center for the Study of Healthcare Provider Behavior, Veterans Health Administration, North Hills, CA
Lillian Gelberg, MD, MSPH , Family Medicine, University of California, Los Angeles, Los Angeles, CA

The U.S. Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program—the VA’s Housing First effort—is central to efforts to end Veteran homelessness. Yet, little is known about healthcare utilization patterns associated with achieving HUD-VASH housing.


We compare health service utilization at the VA Greater Los Angeles (VAGLA) among: 1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veterans); 2) currently homeless Veterans; 3) housed, low-income Veterans not in HUD-VASH; and 4) housed, not low-income Veterans. We performed a secondary database analysis of Veterans (n=62,459) who received VAGLA care between 10/1/2010-9/30/2011. We described medical/surgical and mental health utilization (inpatient, outpatient, and Emergency Department (ED)). We controlled for demographics, need, and primary care use in regression analyses of utilization data by housing and income status.


HUD-VASH Veterans had more inpatient, outpatient, and ED use than currently homeless Veterans. Adjusting for demographics and need, HUD-VASH Veterans and the low-income housed had similar likelihoods of medical/surgical inpatient and outpatient utilization, compared to the housed, not low-income group. Adjusting first for demographics and need (model 1), then also for primary care use (model 2), HUD-VASH Veterans had the greatest decrease in incident rates of specialty medical/surgical, mental health, and ED care from models 1 to 2, becoming similar to the currently homeless, compared to the housed, not low-income group.


Our findings suggest that currently homeless Veterans underuse healthcare relative to housed Veterans. HUD-VASH may address this disparity by providing housing and linkages to primary care.

Learning Areas:

Program planning
Provision of health care to the public
Public health or related research

Learning Objectives:
Describe differential patterns of health service utilization for patients by housing and income status. Assess the role of supportive housing and primary care in health service utilization for patients who have experienced homelessness.

Keyword(s): Homelessness, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a psychiatrist and health services researcher focused on homeless populations.
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.