The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #58430

Alexander Cowell, PhD, Behavioral Health Economics Program, RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, 919 541 8754, cowell@rti.org, David E. Pollio, PhD, School of Social Work, Washington University, One Brookings Dr., Box 1196, St. Louis, MO 63130-4899, and Carol S. North, MD, MPE, School of Medicine, Washington University, Department of Psychiatry, 660 S Euclid, CB 8134, Renard Building, Room 2210, St. Louis, MO 63110.

Health services for the homeless span a number of settings. Appropriate methods of estimating service types and unit costs allows comparisons within and across settings, facilitating an optimal mix of services. This paper presents methods for developing comparable costs and results across sectors of care for a comprehensive array of health services to the homeless in St. Louis. As part of a larger study, cost data were collected using standardized instruments from 35 agencies providing services to the homeless in St. Louis. Six settings were identified and Cost Analysis Program (CAP) instruments developed for each, including psychosocial rehabilitation, emergency shelter, transitional housing, inpatient drug abuse, outpatient drug abuse, outpatient mental health. Service-level unit costs were estimated for 24 defined services. The CAP instrument had two parts, one collecting agency financial data, the second labor and time resources for individual services. Inpatient mental health cost estimates were provided directly by participating hospitals. Case examples are presented from each setting of care. Differences across settings in service-level costs were found, attributable to three sources of variation: a) number and qualifications of staff used to deliver the service; b) wage paid to labor providing the service; and c) overhead and administrative costs. Because these costs are comparable between agencies and across settings, they are useful for decision-makers who want to design an effective and efficient mix of health services for the homeless. Methods developed here have utility for costing services across sectors for other underserved populations.

Learning Objectives:

• After this session the participant will be able to:
• i) Articulate the issues and approaches to estimating costs across multiple sectors of care.
• ii) Discuss the differences in costs across sectors and across programs within sectors, and the reasons for these differences.
• iii) Utilize the information from these results to shape service policy for the homeless population.

Keywords: Cost Issues, Homeless Health Care

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: RTI - employer NIDA - grant