Health Care Utilization and Expenditures of Homeless Family Members Before and After Emergency Housing

Am J Public Health. 2018 Jun;108(6):808-814. doi: 10.2105/AJPH.2018.304370. Epub 2018 Apr 19.


Objectives: To describe longitudinal health service utilization and expenditures for homeless family members before and after entering an emergency shelter.

Methods: We linked Massachusetts emergency housing assistance data with Medicaid claims between July 2008 and June 2015, constructing episodes of health care 12 months before and 12 months after families entered a shelter. We modeled emergency department visits, hospital admissions, and expenditures over the 24-month period separately for children and adults.

Results: Emergency department visits, hospital admissions, and expenditures rose steadily before shelter entry and declined gradually afterward, ending, in most cases, near the starting point. Infants, pregnant women, and individuals with depression, anxiety, or substance use disorder had significantly higher rates of all outcomes. Many children's emergency department visits were potentially preventable.

Conclusions: Increased service utilization and expenditures begin months before families become homeless and are potentially preventable with early intervention. Infants are at greater risk. Public Health Implications. Early identification and intervention to prevent homeless episodes, focusing on family members with behavioral health disorders, who are pregnant, or who have young children, may save money and improve family health.

Publication types

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

MeSH terms

  • Adult
  • Child
  • Child, Preschool
  • Emergency Medical Services / statistics & numerical data
  • Female
  • Health Expenditures / statistics & numerical data*
  • Homeless Persons / statistics & numerical data*
  • Hospitalization / statistics & numerical data
  • Housing*
  • Humans
  • Infant
  • Male
  • Massachusetts
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Pregnancy
  • Young Adult