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How to get healthcare to pay for housing?
Joshua D. Bamberger, MD, MPH
Associate Clinical ProfessorFamily and Community Medicine
University of California, San FranciscoSan Francisco Department of Public Health
Why do we provide healthcare?
Mortality DAH vs Regular Care1996-2003
Plaza High Utilizer Study
• 106 Chronically homeless adults• Cost year before housing: $3,132,856 • Cost year after housing: $906,228• Reduction in healthcare costs: $2,226,568 • Cost of program:
$1.1million/year• Reduction in public
cost in first year: $1.1 million
• Direct Access to Housing- 1730 units in 43 buildings– 6 buildings (N=510; 33%) with nurses
• Tailor housing to the needs of an individual• Initially SRO, now new buildings• Priority to people with multiple disabilities• 7.6% HIV+• Housing first, harm reduction, supportive housing
SF Health Dept’s Housing
DAH Portfolio
•
253 286604 678 704 704 878
0 0
177 247 339
689
020040060080010001200140016001800
99-00 2001-2 2003-4 2005-6 2007-8 2009-10
2011-2015
NewMaster-lease
HIV, Homeless and Survival
•
HIV, Homeless and Survival
•
Windsor Empress LeNain PBI CCR West Folsom Dore Plaza 149 Mason 990 Polk Mission Creek
7.6
3.5
6.8
3.9
5.3
2.7
5.0
3.5
2.5
4.0
3.1
R² = 0.388887624467414
Death by Quality of Housing%death
Death Rate/year0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
Death rate Le Nain vs. Mission Creek 2006-2011
Le Nain death %MCSC death %
2010 2011 2012 2013 2014 20150
100
200
300
400
500
600
HennepinLexingtonTacomaFort WorthBirmingham
Measured
-------Projected
______
Number of Homeless Veterans in 5 Communities with Greater than 40% reduction 2010-2012
“It costs less to house homeless people than to leave them on the streets and in shelters.”
-Shaun DonovanU.S. Secretary of Housing & Urban Development
The Daily Show, March 5, 2012
We know that housing..• Improves health• Reduces cost• Improves quality of life• Delivers on a moral imperative to care for the
people who cannot care for themselves
Tale of Two Patients
How can we have healthcare pay for housing?
How to get healthcare to pay for housing?
Joshua D. Bamberger, MD, MPH
Associate Clinical ProfessorFamily and Community Medicine
University of California, San FranciscoSan Francisco Department of Public Health
