A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance

S.W. Hwang, C. Chambers, S. Chiu, M. Katic, A. Kiss, D.A. Redelmeier and W. Levinson

American Journal of Public Health, 2013, vol. 103, issue S2, S294-S301

Abstract: Objectives. We comprehensively assessed health care utilization in a population-based sample of homeless adults and matched controls under a universal health insurance system. Methods.We assessed health care utilization by 1165 homeless singlemen and women and adults in families and their age- and gender-matched low-income controls in Toronto, Ontario, from 2005 to 2009, using repeated-measures general linear models to calculate risk ratios and 95% confidence intervals (CIs). Results. Homeless participants had mean rates of 9.1 ambulatory care encounters (maximum = 141.1), 2.0 emergency department (ED) encounters (maximum = 104.9), 0.2 medical-surgical hospitalizations (maximum = 14.9), and 0.1 psychiatric hospitalizations per person-year (maximum = 4.8). Rate ratios for homeless participants compared with matched controls were 1.76 (95% CI = 1.58, 1.96) for ambulatory care encounters, 8.48 (95% CI = 6.72, 10.70) for ED encounters, 4.22 (95% CI = 2.99, 5.94) for medical-surgical hospitalizations, and 9.27 (95% CI = 4.42, 19.43) for psychiatric hospitalizations. Conclusions. In a universal health insurance system, homeless people had substantially higher rates of ED and hospital use than general population controls; these rates were largely driven by a subset of homeless persons with extremely high-intensity usage of health services.

Keywords: adult; ambulatory care; article; Canada; cohort analysis; emergency health service; female; health service; homelessness; hospitalization; human; insurance; male; middle aged; socioeconomics; statistics; United States; utilization review; Canada; epidemiology; health service; homelessness; statistics and numerical data; United States; utilization, Adult; Ambulatory Care; Canada; Cohort Studies; Emergency Service, Hospital; Female; Health Services; Homeless Persons; Hospitalization; Humans; Male; Middle Aged; Socioeconomic Factors; United States; Universal Coverage, Adult; Ambulatory Care; Canada; Cohort Studies; Emergency Service, Hospital; Female; Health Services; Homeless Persons; Hospitalization; Humans; Male; Middle Aged; Socioeconomic Factors; United States; Universal Coverage (search for similar items in EconPapers)
Date: 2013
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Citations: View citations in EconPapers (10)

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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2013.301369_0

DOI: 10.2105/AJPH.2013.301369

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