Volume 53 | Number S3 | December 2018

Abstract List

Richard E. Nelson Ph.D., Ying Suo M.Stat., Warren Pettey M.P.H., C.P.H., Megan Vanneman Ph.D., M.P.H., Ann Elizabeth Montgomery Ph.D., Thomas Byrne Ph.D., Jamison D. Fargo Ph.D., Adi V. Gundlapalli M.D., Ph.D.


To estimate health care utilization and costs incurred by homeless Veterans relative to nonhomeless Veterans and to examine the impact of a homelessness program on these outcomes.

Data Sources/Study Setting

Combined Department of Veterans Affairs () administrative and Medicare claims data.

Study Design

Observational study using longitudinal data from Veterans engaged with the system and enrolled in Medicare. Veterans with administrative evidence of homelessness at any point during 2006–2010 were matched on period of military service to Veterans with no evidence of homelessness.

Principal Findings

Experience of homelessness was associated with 1.37 (95 percent  = 1.34–1.40) and 0.16 (95 percent  = 0.14–0.17) more outpatient encounters per quarter in and non‐ settings, respectively, and 1.31 (95 percent  = 1.30–1.32) and 0.49 (95 percent  = 0.48–0.49) more inpatient days per quarter in and non‐ hospitals, respectively. These were associated with higher costs. Relative to stably housed Veterans less than 65 years of age, those enrolled in a homelessness program had 94.4 percent (95 percent  = 90.7 percent–98.1 percent) more outpatient visits but 5.5 percent (95 percent  = 3.0 percent–7.9 percent) fewer Medicare outpatient visits.


Homelessness was associated with an increase in and Medicare utilization and cost. A homelessness program decreased use of Medicare outpatient services.