Housing subsidies reduce healthcare costs for vulnerable ex-combatants

Ensuring that ex-combatants have stable housing not only reduces homelessness but also lowers the cost of providing them with state-funded health care, according to a national study by scientists from the University of Utah. The researchers found that veterans who received Temporary Financial Assistance (AFT) from the Department of Veterans Affairs (VA) to acquire or maintain housing had fewer hospital visits and an average reduction in health care costs of $ 2,800 over a two-year period as veterans who did not receive this benefit.

Researchers say this model could help nonprofits and other federal, state and local governments better serve homeless Americans who are not veterans.

“Bringing homeless veterans into stable housing is desirable for a variety of social, health, economic and moral reasons,” says Richard E. Nelson, Ph.D., study lead author and professor. research associate in internal medicine at U of U Health. “In this case, the general conclusion of our research is that providing veterans with temporary financial assistance helps them find stable housing and reduces health care costs, especially hospital health care costs. the average person or the taxpayer. ”

The study appears in the May issue of Health affairs.

Every night, about 40,000 US veterans are homeless, according to the US Department of Housing and Urban Development. Thousands more risk losing their homes every day, says Nelson.

Homelessness is associated with a myriad of health problems, including HIV / AIDS, malnutrition, skin infections, tuberculosis and pneumonia and drug addiction. As a result, VA’s specialized homelessness programs provide health care to nearly 150,000 homeless veterans each year.

In previous research, Nelson and colleagues found that homeless veterans or those at risk of becoming homeless who received AFE provided by the Veterans Family Support Services (SSVF ) VAs were more likely to have stable housing 90 days after enrolling in the program than those who did not receive the program’s short-term grants.

Based on this finding, the scientists set out to determine whether AFE also had an impact on the use of VA health care facilities by these veterans. They identified 29,184 ex-combatants who had received AFE through the AFS program in 49 states as well as 11,229 who participated in other aspects of AFE but did not receive AFE.

The researchers analyzed data on these veterans from two years before SSVF enrollment to two years after in quarterly increments. Overall, health care costs have risen sharply in the eight quarters leading up to SSVF enrollment. However, health care costs decreased by an average of $ 352 per quarter for SSVF veterans receiving SFA after enrollment compared to those who did not receive this benefit. This decrease was constant regardless of the amount of AFE received, which averaged about $ 6,000 during SSVF participation, or about three months on average.

The magnitude of the decrease was larger for those who were homeless at the time of enrollment than for those who were on the brink of enrollment but stayed at home because of their AFE allowance. Part of the reason for this difference is that homeless veterans are more likely to be hospitalized.

In some cases, decreasing health care costs have offset the total amount of AFE allocated to these ex-combatants, potentially reducing overall expenses for their care and well-being. The researchers say the finding could have implications for efforts to reduce homelessness and the health problems that accompany it in other populations.

“Historically, housing and health care have been seen as separate things,” says Nelson. “By showing that they are linked – that improving a person’s housing situation could also improve their health – this finding could have a big impact on how we approach these challenges among veterans and other citizens in the future. “

Among the limitations of the study, healthcare costs for veterans who use non-VA providers were not included in the analysis. Veterans are also more likely than the general population to be male and to have a higher risk of substance abuse and mental illness, two conditions commonly associated with homelessness.

In the future, the researchers plan to examine whether other SSVF services such as legal aid, credit counseling and obtaining VA benefits can improve housing and health care outcomes. for homeless or at-risk veterans. Additionally, since reducing health care spending does not necessarily improve health, they will explore more direct measures, such as mortality.

“Over the past 10 to 15 years, homelessness policies have evolved into interventions like the one we studied,” says Thomas H. Byrne, Ph.D., lead author of the study, researcher at the VA Bedford Healthcare System. in Bedford, Massachusetts, and assistant professor of social work at Boston University. “Yet, the evidence for their effectiveness is limited to date. Our findings help provide much-needed evidence on the impact of such interventions.”

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In addition to Dr. Nelson, University of Utah health researchers Ying Suo, James Cook, Warren Pettey, and Tom Greene, contributed to this study. Other contributors included scientists from the University of Alabama at Birmingham, University of Norte Dame, University of California Los Angeles, Boston University and the Health Sciences Center. from the University of Texas at San Antonio.

The study titled “Temporary Financial Aid Reduced Health Care Costs for Unstable Veterans”, appears in Health affairs. It was supported by the Department of Veterans Affairs (VA) Health Services Research and Development.

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About Christopher Easley

Christopher Easley

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