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. 2013 Dec;103 Suppl 2(Suppl 2):S294-301.
doi: 10.2105/AJPH.2013.301369. Epub 2013 Oct 22.

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

Stephen W Hwang  1 , Catharine Chambers, Shirley Chiu, Marko Katic, Alex Kiss, Donald A Redelmeier, Wendy Levinson
Affiliations

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

Stephen W Hwang et al. Am J Public Health. 2013 Dec.

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 single men 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.

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Figures

FIGURE 1—
FIGURE 1—
Venn diagram showing patterns of health care use among homeless participants over a mean follow-up duration of 3.9 years: Toronto, Ontario, 2005–2009.
FIGURE 2—
FIGURE 2—
Annual number of health care encounters among homeless participants and age- and gender-matched low-income control individuals by demographic group for (a) ambulatory care, (b) emergency department care, (c) medical-surgical hospitalization, and (d) psychiatric hospitalization: Toronto, Ontario, 2005–2009.
FIGURE 3—
FIGURE 3—
Estimated health care expenditures per year among 1165 homeless participants and 1165 age- and gender-matched low-income control individuals, by type of health care: Toronto, Ontario, 2005–2009. Note. Expenditures are based on mean weighted cost episode-level estimates from the Medical Expenditure Panel Survey for hospital inpatient services, emergency room services, and office-based physician services; estimated costs are in US dollars.
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