Online Program

Impact of the Great Recession on primary care access for the homeless in New York using the State Inpatient Database

Tuesday, November 3, 2015

Brandi M. White, PhD, MPH, WISSDOM Center/College of Health Professions, Medical University of South Carolina, Charleston, SC
Walter Jones, PhD, Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC
William P. Moran, MD, MS, Division of General Internal Medicine and Geriatrics, College of Medicine, Medical University of South Carolina, Charleston, SC
Kit N. Simpson, DrPH, Department of Health Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, SC
Background: Periods of economic instability, such as the recent Great Recession, may increase preventable hospitalizations because of increased barriers to accessing primary care. For underserved populations such as the homeless, these barriers may be more pronounced due to limited resources in the health care safety net during economic downturns. We studied the impact of the recession on primary care access for the homeless in New York.  

Methods: We used hospitalizations for ambulatory care sensitive (ACS) conditions as a proxy measure for primary care access. ACS admissions were identified in the NY State Inpatient Database from 2006-2012. ACS hospitalization rates were calculated for the homeless (n=12,343) and non-homeless (n=292,866). Multivariable linear regression was used to investigate the recession’s impact on rates.

Results: Mean ACS admission rates were 64.60 (±9.0) per 10,000 homeless persons and 5.28 (±0.2) per 10,000 census persons (p<.0001). In the model predicting overall rates, rates for homeless were higher (β=57.68; p<.0001). The recession did not have an effect on combined (homeless and non-homeless) rates (p=0.2147), but did increase homeless rates (β=7.71; p=0.0240). Combined rates decreased over time (β=-0.55; p<.0001) and were lower in 2006 (β=-5.49; p=0.0472). Subsequent models found that rates for homeless seniors, females, minorities, and the uninsured were higher during the recession (p<0.05).

Discussion: The recession in NY exacerbated disparities for homeless subgroups that traditionally experience disparities in the general population. To mitigate the effect of economic downturns on healthcare access for underserved populations, future policies should focus on increasing the availability of affordable care and strengthening safety net resources.

Learning Areas:

Provision of health care to the public
Public health or related public policy

Learning Objectives:
Describe the impact of the Great Recession on primary care access for the homeless in New York

Keyword(s): Accessibility, Homelessness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Brandi White is a PhD Candidate in health services research at the Medical University of South Carolina. She has her Master’s in Public Health from the University of Minnesota in community health education. Her past research has focused on improving health outcomes among low-income populations, such as the homeless and public housing residents. Currently, her research focuses on improving access to healthcare services among underserved 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.