One of the reasons is that homeless people who arrive at the hospital with medical or surgical problems also have underlying health issues and end up staying longer, often because there is no place to send them after their initial medical crisis has been treated.
In addition, homeless patients with psychiatric illness arrive at the hospital much sicker than others, the study found.
Lead author Dr. Stephen Hwang, a research scientist with the hospital’s Centre for Research on Inner City Health, said the findings suggest that the cost of hospitalizing people who are homeless “has a substantial impact on the health care system.”
The researchers analyzed a group of 90,345 housed and 3,081 homeless patients admitted to St. Michaels over a five-year period. The 500-bed hospital in downtown Toronto accounts for about one quarter of all hospitalizations of homeless people in the city.
After adjusting for age, sex, and severity of illness, the study found that hospital stays for patients who were homeless cost $2,599 more than those who were housed.
In a single year, 100 homeless people will have 23 hospitalizations, compared to just 5 hospitalizations in 100 people in the general population. For patients in the study, the average cost of a hospital stay was around $13,500 per person.
One of the biggest issues surrounding the cost of caring for homeless patients is that many need to be discharged to another institution, such as a rehabilitation or long-term care facility. Often these patients lack a support system to return to and have to wait for a vacancy in a homeless shelter.
Previous studies have found that respite facilities, or infirmaries, are an effective and less expensive alternative to keeping homeless patients in the hospital. Unlike shelters, infirmaries provide nursing and medical care and do not require people to leave each morning.
However, there is only one infirmary open to all homeless men and women in Toronto, at the Sherbourne Health Centre. A second infirmary at Seaton House accepts primarily men who were living at Seaton House prior to their hospitalization.
The severity of illness in homeless patients with psychiatric problems at the time of admission contributes to the high costs of treating those patients, according to Hwang. This could reflect both the limited availability of mental health services for the homeless in the community and the necessity to have severe symptoms in order to be hospitalized.
“Assertive outreach through community health programs may lower costs by reducing the duration of psychiatric hospitalization among homeless people.” Hwang said in a release.
Study co-author James Weaver noted that the $2,500 figure was almost exactly the same as that found in a similar study conducted in New York City in 1998—the only other study on the topic—indicating that Canada’s universal health insurance does not play a role.
“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,” he said.
The St. Michael’s study was published in the March issue of Medical Care, a journal of the American Public Health Association.
