Deriving costs of service use among an urban homeless population

Abstract

The purpose of this study was to describe a novel approach to calculating service use costs across multiple domains of service for homeless populations. A randomly-selected sample of homeless persons was interviewed in St. Louis, MO and followed for two years. Service- and cost-related data were collected from homeless individuals and from the agencies serving them. Detailed interviews of study participants and of agency personnel in specific domains of service (medical, psychiatric, substance abuse, homeless maintenance, homeless amelioration services) were conducted using a standardized approach. Service utilization data were obtained from agency records. Standardized service-related costs were derived and aggregated across multiple domains from agency-reported data. Housing status was not found to be significantly associated with costs. Although labor intensive, this approach to cost estimation allows costs to be accurately compared across domains. These methods could potentially be applied to other populations.

A Prospective Study of the Associations Among Housing Status and Costs of Services in a Homeless Population

“…In addition, there is no consensus on how attaining housing affects service use costs. In contrast to our research (7,8), Larimer and colleagues (3) found that attaining housing was associated with reduced medical care costs.…”

“…Details about the baseline characteristics of this sample of 255 homeless individuals have been previously reported (5,8). To summarize, the sample was predominantly African American (N=192, 75%) and male (N=187, 73%), with a high school education on average (N=149 of 249 participants; 60%).…”

“…Missing data were imputed by using previously described methods (8). Service use costs among pairs of housing groups were compared in bivariate analyses by using nonparametric Wilcoxon-Mann-Whitney U tests (PROC NPAR1WAY in SAS) to accommodate instances of nonnormal data.…”

“…Using structured instruments that were standardized across agencies, we collected study participants' service use and cost data from the agencies for the two follow-up years. Service use data collected from the agencies were combined with the self-report service use data from interviews of the homeless individuals (8). This method of data collection contributes to the literature in two main ways.…”

“…Details of the development and definition of service use and cost variables for this study are provided elsewhere (8). The main service use categories for this analysis are medical, psychiatric, substance abuse, homeless maintenance and amelioration, and total services.…”