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. 2015 Nov;60(11):475-87.
doi: 10.1177/070674371506001103.

Housing First Impact on Costs and Associated Cost Offsets: A Review of the Literature

Angela Ly  1 , Eric Latimer  2
Affiliations

Housing First Impact on Costs and Associated Cost Offsets: A Review of the Literature

Angela Ly et al. Can J Psychiatry. 2015 Nov.

Abstract
in English, French

Objective: Housing First (HF) programs for people who are chronically or episodically homeless, combining rapid access to permanent housing with community-based, integrated treatment, rehabilitation and support services, are rapidly expanding in North America and Europe. Overall costs of services use by homeless people can be considerable, suggesting the potential for significant cost offsets with HF programs. Our purpose was to provide an updated literature review, from 2007 to the present, focusing specifically on the cost offsets of HF programs.

Method: A systematic review was performed on MEDLINE and PsycINFO as well as Google and the Homeless Hub for grey literature. Study characteristics and key findings were extracted from identified studies. Where available, impact on service cost associated with HF (increase or decrease) and net impact on overall costs, taking into account the cost of HF intervention, were noted.

Results: Twelve published studies (4 randomized studies and 8 quasi-experimental) and 22 unpublished studies were retained. Shelter and emergency department costs decreased with HF, while impacts on hospitalization and justice costs are more ambiguous. Studies using a pre-post design reported a net decrease in overall costs with HF. In contrast, experimental studies reported a net increase in overall costs with HF.

Conclusions: While our review casts doubt on whether HF programs can be expected to pay for themselves, the certainty of significant cost offsets, combined with their benefits for participants, means that they represent a more efficient allocation of resources than traditional services.

Objectif :: L’approche « Logement d’abord » (LA), destinée aux personnes en situation d’itinérance chronique ou épisodique, offre un accès rapide au logement permanent combiné à des services intégrés de traitement, de soutien et de réadaptation dans la communauté. Cette approche prend rapidement de l’expansion en Amérique du Nord et en Europe. Les coûts associés à l’itinérance sont considérables, suggérant un potentiel d’économies substantielles avec LA. Notre objectif est d’offrir une revue de littérature à jour, de 2007 à aujourd’hui, portant spécifiquement sur l’impact de LA sur les coûts d’utilisation de services.

Méthode :: Nous avons effectué une revue systématique à partir de MEDLINE et de PsycINFO, ainsi que de Google et du Rond-point de l’itinérance. Les caractéristiques des études et leurs résultats ont été extraits, notamment l’effet de LA sur les coûts d’utilisation de services ainsi que son impact net sur les coûts totaux.

Résultats :: Nous avons retenu 12 études publiées (4 à répartition aléatoire et 8 quasi-expérimentales) et 22 études inédites. Les coûts des refuges et des visites à l’urgence diminuent avec LA tandis que les effets sur les coûts de justice et des hôpitaux sont ambigus. Les études pré-post ont relevé une nette diminution des coûts totaux alors que les études expérimentales ont relevé une augmentation avec LA.

Conclusions :: Bien que notre revue mette en doute la capacité des programmes LA à faire leurs frais, la certitude d’une compensation significative des coûts, alliée aux bénéfices aux participants, signifie que LA représente une allocation plus efficiente des ressources que les services traditionnels.

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References

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