The New England Journal of Medicine
Volume 338(24); Jun 11, 1998; pp 1734-1740
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Hospitalization Costs Associated with Homelessness In New
York City
by Salit, Sharon A.; Kuhn, Evelyn M.; Hartz, Arthur J.; Vu, Jade M.;
Mosso, Andrew L.
>From the New York City Health and Hospitals Corporation, New York
(S.A.S., J.M.V., A.L.M.); the Department of Emergency Medicine,
Medical College of Wisconsin, Milwaukee (E.M.K.); and the Department
of Family Medicine and the Public Policy Center, University of Iowa,
Iowa City (A.J.H.). Address reprint requests to Ms. Salit at the
United Hospital Fund, Empire State Bldg., 350 Fifth Ave., 23rd Fl.,
New York, NY 10118.
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Abstract
Background: Homelessness is believed to be a cause of health problems
and high medical costs, but data supporting this association have
been difficult to obtain. We compared lengths of stay and reasons for
hospital admission among homeless and other low-i ome persons in New
York City to estimate the hospitalization costs associated with
homelessness.
Methods: We obtained hospital-discharge data on 18,864 admissions of
homeless adults to New York City's public general hospitals
(excluding admissions for childbirth) and 383,986 nonmaternity
admissions of other low-income adults to all general hospitals in
New York City during 1992 and 1993. The differences in length of
stay were adjusted for diagnosis-related group, principal diagnosis,
selected coexisting illnesses, and demographic characteristics.
Results: Of the admissions of homeless people, 51.5 percent were for
treatment of substance abuse or mental illness, as compared with
22.8 percent for the other low-income patients, and another 19.7
percent of the admissions of homeless people were for trauma,
respiratory disorders, skin disorders, and infectious diseases
(excluding the acquired immunodeficiency syndrome [AIDS]), many of
which are potentially preventable medical conditions. For the
homeless, 80.6 percent of the admissions involved either a principal
or a secondary diagnosis of substance abuse or mental illness -
roughly twice the rates for the other patients. The homeless
patients stayed 4.1 days, or 36 percent, longer per admission on
average than the other patients, even after adjustments were made
for differences in the rates of substance abuse and mental illness
and other clinical and demographic characteristics. The costs of the
additional days per discharge averaged $4,094 for psychiatric
patients, $3,370 for patients with AIDS, and $2,414 for all types of
patients.
Conclusions: Homelessness is associated with substantial excess
costs per hospital stay in New York City. Decisions to fund housing
and supportive services for the homeless should take into account
the potential of these services to reduce the high costs of
hospitalization in this population. (N Engl J Med 1998;338:1734-40.)
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