Inequality Public Health

Should hospitals pay for housing for ED frequent flyers?

That is one approach being explored in Philadelphia according to an article in Kaiser Health News. Using funding from Temple University, two Pennsylvania Medicaid health plans, and some grant funding, the Template University Health System:

…launched a two-year program last year to help 25 homeless Medicaid patients who frequently use its emergency room and other ERs in the city by providing them free housing, and caseworkers to help them access other health and social services. It helps them furnish their apartments, connects them to healthy delivered meals and assists with applications for income assistance such as Social Security. To qualify, participants had to have used the ER at least four times in the previous year and had at least $10,000 in medical claims that year.

Temple has seen promising results when comparing patients’ experiences before the study to the first five months they were all housed. In that time, the participants’ average number of monthly ER visits fell 75% and inpatient hospital admissions dropped 79%.

At the same time, their use of outpatient services jumped by 50% — an indication that patients are seeking more appropriate and lower-cost settings for care.

The program is not cheap, however. It cost $28,000 per person. Nevertheless, according to a Kaiser Family Foundation study last fall, over half of states are implementing or expanding Medicaid programs that address social determinants of health.

Not all interventions addressing social determinents of health have the anticipated impact. Consider the free rideshare program from another Philadelphia university and my alma mater, the University of Pennsylvania:

When doctors at a primary care clinic here noticed many of its poorest patients were failing to show up for appointments, they hoped giving out free rides would help. But the one-time complimentary ride didn’t reduce these patients’ 36% no-show rate at the University of Pennsylvania Health System clinics…

Many of the patients did not take advantage of the ride because they were either saving it for a more important medical appointment or preferred their regular travel method, such as catching a ride from a friend, a subsequent study found.

In short, addressing social determinants of health is a laudable goal. Finding the most cost-effective ways to achieve these goals, however, can be challenging in practice.

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