Hospitalization increases costs of treating homeless
May 1, 2000 2 minutes read
Hospitalization increases costs of treating homeless
Housing, early care could reduce price tag
Homeless TB patients without insurance and homeless TB patients with HIV infection run up bigger hospital bills than other TB patients — on average, about $2,000 more, a recent study found.1
To help trim those costs, programs should provide free housing and early access to medical care, according to Suzanne Marks, MPH, medical epidemiologist with the Division of TB Elimination (DTBE) at the Centers for Disease Control and Prevention in Atlanta and lead author of the study.
The higher price tag reflects two aspects of hospitalization costs that Marks looked at: frequency and duration of stay. In general, HIV-infected homeless TB patients tended to have more frequent hospital stays than their housed counterparts. Providing early access to available health care could help homeless HIV-infected persons get testing and counseling and may help them avoid progressing from TB infection to full-blown disease, says Marks.
As for uninsured homeless TB patients, providing alternative housing could be expected to help them avoid long stays, assuming they’re in the hospital at least in part for lack of a better place to go.
Many TB control programs are notable for strides they’ve made in providing housing. San Francisco, Seattle, New York City, San Diego, Los Angeles, and Phoenix all boast strong alternative housing programs, says John Seggerson, associate director for external relations at the DTBE. "We encourage other programs to establish working relationships with their local and state housing authorities, too," he adds.
Housing program saves money
For HIV-infected TB patients, Marks adds, there’s an important federal housing program known as Housing Opportunities for Patients with AIDS (HOPWA). "It’s hard to overestimate the value of programs like HOPWA," she notes.
Taxpayers generally get stuck paying for the extra $2,000 in hospital costs homeless TB patients incur, at least in instances where patient costs aren’t covered by Medicaid or by benefits available to veterans, she says. At about $35 a day for food, meals, and directly observed therapy, providing alternative housing is a bargain, since hospital rooms run up to 20 times that much, Marks says.
Severity of illness wasn’t evaluated in her study, she notes, so it’s hard to know how many homeless TB patients would benefit from the interventions she proposes and how many would wind up in the hospital regardless.
Reference
1. Marks SM, Taylor Z, Burrows NR, et al. Hospitalization of homeless persons with TB in the United States. Am J Publ Health 2000; 90:435-438.
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