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

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

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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Ambulatory Care / statistics & numerical data
  • Canada / epidemiology
  • Cohort Studies
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Health Services / statistics & numerical data*
  • Homeless Persons / statistics & numerical data*
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Socioeconomic Factors
  • United States / epidemiology
  • Universal Health Insurance