Recently, policy discussions are increasingly accounting for the social determinants of health when considering different policy measures. As more studies emerge demonstrating the links between social determinants such as income, education, early childhood development, and housing and the health and wellbeing of people and communities, a variety of stakeholders are beginning to consider the return on investment for addressing the aspects of human life that impact people’s health and wellbeing. As health care costs continue to rise without quality of care following suit, consensus around health care reform is also building and many health care leaders are becoming increasingly aware that the most significant drivers of health care costs exist beyond the realms of health care settings.
The top 5 percent of hospital users, who tend to be overwhelmingly poor and housing insecure, are estimated to consume 50 percent of health care costs. Additionally, homelessness is associated with increased risk of emergency department visits and hospitalizations that could have potentially been avoided with proper management of chronic conditions. Consequently, many in the health care sector are increasingly seeing the potential value of addressing housing needs as an essential tool in chronic care management as well as a means for enabling health and wellness. Notwithstanding efforts of the Affordable Care Act to increase access to care, urban homelessness in the United States has been correlated with preventable emergency department visits and hospitalizations even when controlling for health insurance coverage. As such, employing efforts to address the social welfare and primary care needs of homeless populations to reduce the risk of preventable emergency department visits and hospitalizations may be a measure of great value.
At the federal level, the U.S. Departments of Housing and Urban Development and Health and Human Services have identified these efforts as a worthwhile investment in the wellbeing of our nation. Over the years, the two departments have collaborated on different initiatives with the shared understanding that integrating housing and health interventions can conceivably improve health outcomes and reduce health care costs.
We are seeing even greater strides in collaboration at the state and local level. A recent study published in the Health Services Research Journal by Sungwoo Lim and colleagues evaluated one such effort in New York and found that a supportive housing program positively affected both housing stability and preventable health care visits among homeless families. The evaluation of the New York/New York III supportive housing program was completed to assess the impact of housing stability among heads of chronically homeless families with serious mental illness, substance abuse disorders, physical disabilities, or HIV/AIDS. The study also tested whether housing stability effects the association between supportive housing and preventable emergency department visits and hospitalizations.
The study found that 87 percent of program residents experienced housing stability in two years postbaseline. Additionally, the findings of the study showed that compared with unstably housed heads of families in the comparison group, those in the treatment group were 0.6 times as likely to make preventable emergency department visits postbaseline. This decline in preventable emergency department visits results in an increase in health care costs savings, further supporting the business case for investing in supportive housing.
There has been increased support from policymakers as more research reveals the benefits of supportive housing on the health and wellbeing of individuals and communities. AcademyHealth supported one such effort through our Community Health Peer Learning Program in 2016, assisting All Chicago Making Homelessness History and the University of Illinois Hospital and Health Sciences System (UI Health) to build capacity to improve population health by better using shared data. In Chicago, the team worked to improve care coordination for residents who were housing insecure or homeless by integrating data from UI Health’s electronic health records with information about housing status from the Homeless Management Information System managed by All Chicago.
The business case for future collaboration between the housing and health sectors is continuously being strengthened. As a growing body of evidence demonstrates the health and societal benefits of safe, affordable and supportive housing interventions, policymakers should continue to seek innovative partnerships across sectors to integrate health and housing services.