Hospitalized homeless patients may incur higher costs

Homeless individuals, when hospitalized, may cost on average $2,500 more per stay than other patients because of seriously related health conditions and longer lengths of stay, Canadian researchers report in the journal, Medical Care.

The researchers, based at a 500-bed academic teaching hospital in Toronto, reviewed administrative data on 93,426 admissions collected over a five-year period. These data included identifiers for 3,081 patients who were homeless. Associations between the patients' homeless status and costs were examined and stratified by medical, surgical and psychiatric services.

Stephen Hwang, the study's lead author and a research scientist at the hospital, found higher costs were linked in part to the fact that homeless individuals with medical or surgical problems stayed in the hospital longer--often after they no longer needed acute care.

This was because they were awaiting discharge to other healthcare facilities or were not well enough to return to a shelter, or the shelter was unable to receive them. Also, the higher costs for hospitalizing homeless people with psychiatric problems probably were due to the severity of their illnesses when they were admitted, Hwang said.

James Weaver, a study co-author, observed that the extra $2,500 for hospitalizing a homeless person was nearly the same as the amount found in the only other study on the topic--conducted in New York City in 1998.

"The fact that excess hospitalization costs for homeless people were observed in this study conducted in Canada shows that these higher costs are not eliminated by the presence of universal health insurance," Weaver said.

For more details:
- here's the abstract for the Medical Care study
- read the news release