Metrics details. Evidence is limited about healthcare cost disparities associated with homelessness, particularly in recent years after major policy and resource changes affecting people experiencing homelessness occurred after the onset of the COVID pandemic.
We estimated 1-year healthcare expenditures, overall and by type of service, among a representative sample of people experiencing homelessness in Toronto, Canada, in and , and compared these to costs among matched housed and low-income housed individuals. Data from individuals experiencing homelessness participating in the Ku-gaa-gii pimitizi-win cohort study were linked with Ontario health administrative databases.
Groups were followed over 1 year to ascertain healthcare expenditures, overall and by healthcare type. Generalized linear models were used to assess unadjusted and adjusted mean cost ratios between groups. Participants experiencing homelessness had nearly seven times 6. After adjustment for number of comorbidities and history of healthcare for mental health and substance use disorders, participants experiencing homelessness had nearly six times adjusted MR 5.
The two housed groups had similar costs. Homelessness is associated with substantial excess healthcare costs. Programs to quickly resolve and prevent cases of homelessness are likely to better meet the health and healthcare needs of this population while being a more efficient use of public resources. Peer Review reports. Homelessness and housing instability are significant public health challenges in Canada, with one in five Canadians directly or indirectly affected [ 1 ] People experiencing homelessness have consistent disparities in adverse health outcomes and mortality compared to housed counterparts [ 2 , 3 , 4 ], even after accounting for potential confounders such as socioeconomic status and comorbidities [ 4 , 5 ].
These disparities have historically resulted in this population incurring notably high average healthcare costs relative to housed individuals [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. The onset of COVID has further compounded the challenges faced by people experiencing homelessness, both through direct impacts of the SARS-CoV-2 virus through elevated infection rates and subsequent adverse outcomes [ 15 , 16 , 17 ], as well as through indirect changes including disruptions to essential services [ 17 , 18 , 19 ] and growing toxicity of drug supply [ 20 , 21 ].
