The effect of the global financial crisis on preventable hospitalizations among the homeless in New York State

Abstract

Objective Periods of economic instability may increase preventable hospitalizations because of increased barriers to accessing primary care. For underserved populations such as the homeless, these barriers may be more pronounced due to limited resources in the health care safety net. This study examined the impact of the global financial crisis of 2007-2008 on access to care for the homeless in New York State. Methods Hospitalizations for ambulatory care sensitive conditions (ACSCs) were used as a proxy measure for primary care access. Admissions for ACSCs were identified in the New York State Inpatient Database from 2006 to 2012. Hospitalization rates for ACSCs were calculated for the homeless and nonhomeless. Multivariable linear regression was used to investigate the impact of the financial crisis on hospitalization rates for ACSCs. Results The findings indicate that during the financial crisis, homeless adults had significantly higher preventable hospitalizations than nonhomeless adults, and the uninsured homeless had significantly higher preventable hospitalizations when compared to other homeless subgroups. After the financial crisis, preventable hospitalizations for the homeless stabilized but remained at higher rates than those for the nonhomeless. Conclusions These findings are important to developing health policies designed to provide effective care for underserved population such as the homeless.

Hospitals during economic crisis: a systematic review based on resilience system capacities framework

“…Variously, it caused an increase in emergency, complicated and acute care utilization, especially in vulnerable groups (e.g., Spain and Finland) [ 34 , 67 ]. Consequently, the inequity in access to hospital services increased (Spain, Germany) [ 24 , 46 , 47 , 82 ], which highlights the impact of the crisis on the underserved population’s access to quality primary care [ 86 ].…”

“…In this regard, some countries created new governance and leadership structures to coordinate and manage primary care and hospital services (Greece, US) [ 41 , 44 , 45 , 86 ]. Also, several countries conducted hospital integration or closure to reduce hospital care utilization (United States, Canada, Greece, Denmark, Spain) [ 6 , 10 , 25 , 32 , 35 , 39 , 44 , 71 , 76 , 80 , 81 , 87 ].…”

Comparison of Childbirth Delivery Outcomes and Costs of Care Between Women Experiencing vs Not Experiencing Homelessness

“…For each inpatient and hospital-affiliated emergency department discharge, there is an indicator for each patient's housing status reported directly from the hospitals, and this variable has been used in previous studies to identify the housing status of patients. [22][23][24][25][26] Additionally, we used the 2016 American Hospital Association's Annual Survey Database 27 and the 2014 Medicare Cost Reports 28 for data on hospital characteristics.…”

Association of Homelessness with Hospital Readmissions—an Analysis of Three Large States

“…We identified the homelessness status by the homeless indicator that is used by the AHRQ and has also been used in prior analyses. 11,[18][19][20][21] For the purpose of this analysis, a readmission was defined as the first hospitalization within 30 or 90 days of discharge (readmissions within 90 days include readmissions within 30 days of discharge from index hospitalization). Hospitalizations occurring more than 30 or 90 days after discharge were counted as another index hospitalization.…”