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Comparing the Utilization and Cost of Health Services between Veterans Experiencing Brief and Ongoing Episodes of Housing Instability

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Abstract

Housing instability is associated with costly patterns of health and behavioral health service use. However, little prior research has examined patterns of service use associated with higher costs among those experiencing ongoing housing instability. To address this gap, we compared inpatient and outpatient medical and behavioral health service utilization and costs between veterans experiencing brief and ongoing episodes of housing instability. We used data from a brief screening instrument for homelessness and housing instability that has been implemented throughout the US Department of Veterans Affairs (VA) health care system to identify a national sample of veterans experiencing housing instability. Veterans were classified as experiencing either brief or ongoing housing instability, based on two consecutive responses to the instrument, and we used a series of two-part regression models to conduct adjusted comparisons of costs between veterans experiencing brief and ongoing episodes of housing instability. Among 5794 veterans screening positive for housing instability, 4934 (85%) were experiencing brief and 860 (15%) ongoing instability. The average total annual incremental cost associated with ongoing versus brief episodes of housing instability was estimated at $7573, with the bulk of this difference found in inpatient services. Cost differences resulted more from a higher probability of service use among those experiencing ongoing episodes of housing instability than from higher costs among service users. Our findings suggest that VA programmatic efforts aimed at preventing extended episodes of housing instability could potentially result in substantial cost offsets for the VA health care system.

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Acknowledgments

This study was supported by funding from the U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) grant number IIR 13-334 "Identifying and Measuring Risk for Homelessness Among Veterans" and from the VA National Center on Homelessness Among Veterans. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. None of the authors have any conflicts of interest to disclose.

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Authors and Affiliations

  1. Boston University School of Social Work, Boston, MA, USA

    Thomas Byrne, Richard E. Nelson, Ann Elizabeth Montgomery, Emily Brignone, Adi V. Gundlapalli & Jamison D. Fargo

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  1. Thomas Byrne
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  2. Richard E. Nelson
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  3. Ann Elizabeth Montgomery
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  4. Emily Brignone
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  6. Jamison D. Fargo
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Correspondence to Thomas Byrne.

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Byrne, T., Nelson, R.E., Montgomery, A.E. et al. Comparing the Utilization and Cost of Health Services between Veterans Experiencing Brief and Ongoing Episodes of Housing Instability. J Urban Health 94, 54–63 (2017). https://doi.org/10.1007/s11524-016-0110-5

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  • DOI: https://doi.org/10.1007/s11524-016-0110-5

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