A small subset of homeless people in Canada are extremely frequent users of health services, new research has found.
Research conducted by Dr. Stephen Hwang of the Centre for Research on Inner City Health at St. Michael's Hospital in Toronto uncovered that homeless men, women and families have significantly more doctors' appointments and higher hospitalization rates.
For the study Hwang followed 1,165 people over four years on average in Toronto, where there's universal government-funded health insurance, and comprehensive databases that capture all doctors', Emergency Departments, and hospital visits. The homeless people, recruited from shelters and meal programs to take part in the study, were compared with low-income people in the general population of the same age and gender.
Hwang said his study has important policy implications for the delivery of health services, especially given recent legislative changes that expanded Medicaid coverage to low-income Americans. Traditionally, a lack of health insurance has been identified as a significant barrier to obtaining ambulatory care in the United States, resulting in unnecessary ED visits and avoidable hospitalizations.
"The provision of universal health insurance, while important, doesn't fully address the barriers to appropriate health care for this vulnerable population," Hwang said in a statement. "We also need to improve the management of chronic physical and mental illness, and address structural factors such as a lack of affordable housing."
This study found that 95.5 percent of homeless people had at least one encounter with health services during the four-year study. By comparison, 84.2 percent of people in the low-income population of Toronto had at least one encounter with health services.
The study also found that Compared to the general low-income population of Toronto, homeless people who frequented the hospital were 6.59 times more likely to use ambulatory care services, 55.65 times more likely to visit an ED and 55.84 times more likely to be hospitalized in a medical-surgical bed.
Single women who are homeless visit a hospital emergency room an average of more than twice a year, 13 times more often than low-income women who are not homeless. It also shows that single men who are homeless also make an average of two visits a year to an emergency room, nine times more than low-income men who are not homeless.
"This very high intensity use by a relatively small number of homeless people can have a substantial impact on the health care system," Dr. Hwang said.
He said total health care spending for individuals in his study was estimated at $6.7 million U.S. a year, or $5,725 U.S. per person. This is probably a conservative figure, given that homeless people generally have longer inpatient stays and higher hospital costs.
Hwang said that while homeless people are known to have higher rates of chronic and acute medical conditions than the general population, no comprehensive assessment of their health care use has been done previously.
