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The Effects of Housing Insecurity on Health Outcomes and Costs

Can supportive housing programs help lower costs and improve health outcomes?

Over the past 15 years, research has revealed a consistent link between housing and health. A lack of stable, affordable and adequate housing can have severe implications for a patient’s health. Substandard living conditions influence many of the most serious chronic health problems. Housing that is safe, clean and adequately maintained can reduce the likelihood of adverse health outcomes by decreasing the probability of preventable conditions like injuries, neurotoxicity or asthma and it can also reduce the costs associated with care.

The Health-Related Costs of Housing in America

Housing is one of the most impactful unmet social needs in the U.S. Housing as a social determinant of health can mean several things: 1) the physical conditions within a patient’s home, 2) housing affordability, and 3) the lack of a stable living environment. As of January 2017, an estimated 553,742 people in the United States experience homelessness on a given night and in 2016, 30 million households in the United States reported having significant physical or health hazards within their homes. Not only are millions of people at-risk for developing serious health conditions that can lead to poor health outcomes but the costs associated with care are significant.

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According to research published in American Health and Drug Benefits, almost 33% of emergency department visits are made by people experiencing homelessness. The same study found that on average, patients experiencing homelessness visit the emergency department five times annually, and the most frequent users visit them weekly. Each visit costs up to $3,700, amounting to $18,500 per patient spent annually and up to $44,400 for the most frequent users. Emergency departments are not typically equipped to meet many of the underlying, non -clinical needs (i.e., housing) of homeless patients. Housing instability also plays a significant role in increasing costs of care. A study from Boston Medical Center's Children's HealthWatch estimates that housing instability will cost the healthcare industry around $111 billion over next decade.

How Supportive Housing Programs Can Reduce Healthcare Costs

Supportive housing programs can help provide housing security and raise the standard of living, to improve health outcomes and reduce the costs associated with care.

Supportive housing

 Source: Corporation for Supportive Housing

For example, in one study, Massachusetts’ Home and Healthy for Good Program was able to reduce total per person costs of care from $33,190 to $8,603 by providing housing for 766 homeless patients. The study found that six months prior to supportive housing, the participants accumulated 1,812 emergency department visits, 3,163 overnight hospital stays, 847 ambulance rides and 2,494 withdrawal therapy sessions. The estimated total cost per person for measured services amounted to $33,190 per year. After one year in the program, the total per person costs for these same services fell to $8,603. The cost of housing and services through the Home and Healthy for Good Program program amounted to $15,468 per tenant.

In another study, 95 chronically homeless patients with severe alcohol problems were enrolled into a “housing first” program. In the year prior to their entrance into the program, the participants had accumulated a total cost of $8,175,922 in shelter and sobering center use, hospitalizations, publicly funded alcohol and drug treatments, emergency medical services, and Medicaid-funded services. Each participant had an average cost of $4,066 per person per month. After six months in the program, the average monthly cost decreased to $1,492, and after 12 months, it dropped to $958.

Housing Insecurity.pngPatients who are not currently experiencing homelessness but are facing problems with housing insecurity are also enduring treatable yet costly health conditions. Researchers found th at 23.6% of 16,651 respondents reported having issues with housing stability and among the respondents who reported housing instability, the researchers discovered high rates of poor access to care and acute health care use (Fig. 1).

Takeaways

This summary of research confirms that interventions by social services and community partners can have a significant effect on patients experiencing problems with housing. Health plans and providers can benefit from assessing patients for unmet social needs, particularly housing, and connecting them with the appropriate resources to help meet those needs. Housing insecurity is strongly linked to adverse health outcomes and healthcare costs, and without the necessary interventions and resources, health inequity will continue to    deteriorate while costs continue to increase.

Healthify can help. We deliver a leading solution that empowers organizations to find community services for their patients, track social needs across their population, and coordinate care with community-based services. As a partner to health plans, social service agencies, and provider networks working with Medicaid and Medicare members, Healthify enables integrated care to fulfill the promise of a value-based healthcare system and healthy communities.

At Healthify we believe that no one’s health should be hindered by their need. If you’re a healthcare provider or a health plan interested in learning how to connect your patients with social services, we’d love to talk. Connect with us here.

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Topics: Health Spending Homeless Social Determinants of Health