On a recent night this winter, I stood under Chicago’s Dan Ryan Freeway and watched my colleague examine a golf ball-sized abscess on my foot. The patient shivered in pain. “I just kept ignoring it for weeks because I thought it would go away,” he said. We were a team of medical students and doctors providing basic health care to people living on the streets. But because we rely on volunteers and limited supplies, our visits are few and our medical care is basic.
Results from the 2022 One-Time National Count will be released soon and will reveal the state of homelessness in the United States two years into the COVID-19 pandemic. We need our lawmakers and our hospitals to act independently of these findings. We can’t keep waiting for homelessness to skyrocket before we increase health care funding for the homeless – homeless Americans already cost our health care system millions every year.
The homeless population in the United States increased for the fourth consecutive year in 2020. Due to COVID-19 concerns, the results of the 2021 United States homeless count were incomplete and unmatched. Housing people should remain the top priority for policy makers, but it will take time. In the meantime, we must meet the health and health care costs of more than 580,000 homeless Americans. We need to expand the scope of cost-effective health care for the homeless to reduce system-wide expenditures for this population.
One solution: require hospitals to spend part of their mandated community benefit funds to bring health care to the streets, where people live.
Street medicine can help reduce the cost of caring for homeless people by reducing emergency room visits and hospitalizations. Many homeless Americans do not have a primary care physician or do not use community health centers. Often it’s because they don’t want to leave their belongings unattended, they don’t have access to transportation, or they have lost faith in the health care system. As a result, their poorly managed illnesses lead to hospital visits with huge bills. The average homeless person visits the emergency room five times a year, which costs $18,500 a year. When patients are uninsured or unable to pay, hospitals usually take the bill.
Existing street medicine programs have been shown to reduce hospital expenditures. Between 2015 and 2017, Lehigh Valley Health Network in Pennsylvania saved $3.7 million in reduced emergency room visits and hospitalizations after implementing a street medicine team.
Nonprofit hospitals in the United States are already required to devote a portion of their excess profits to “community benefits” in order to qualify for federal income tax exemption. Most hospitals fulfill this obligation by covering the hospitalization costs of low-income patients. However, given the high rates of homelessness in US cities, lawmakers could tighten requirements so that hospitals must dedicate a specific portion of their community benefits to street medicine. If hospitals do not comply, they risk losing their coveted tax-exempt status.
The Mount Carmel Health System in Columbus, Ohio, has already pioneered this use of community benefits to fund a mobile van that visits local homeless encampments to provide basic care and connect patients to social services in the city. community. Similarly, Mission Health System in western North Carolina is directing community benefits to fund a homeless outreach team.
Time and time again, people experiencing homelessness have sought care and left humiliated and angry. One man I spoke to equated being in hospital with animal cruelty – he felt like “a pig in a stall” because he was homeless. Bringing healthcare workers to the streets can restore some of the lost confidence felt by some outside of a traditional healthcare environment.
There are certainly limits to providing health care outside of the hospital. Street medicine teams are struggling to bring important medical supplies to the field. Additionally, redirecting benefits from the hospital community to street care inevitably takes money away from other community improvements. However, street medicine is one of our only tools to combat the out-of-pocket expenses associated with expensive hospital visits.
After a careful flashlight examination of the cell phone under the highway, the volunteer doctor determined that the patient with the swollen foot should go to the hospital. Her abscess had to be drained in a sterile environment to prevent infection and we didn’t have a proper medical van. He was taken to hospital, where he spent a long and expensive night in the emergency room
As we enter the next phase of the COVID-19 pandemic, funding health care for the homeless is more important than ever. More than half a million Americans remain homeless every night. Hospitals have closed due to the financial burden of unpaid medical bills. We need to redouble our efforts to reduce healthcare spending by demanding that our legislators, policy makers and hospitals invest more in street medicine.
Anna Thorndike is a medical student at the University of Chicago and a volunteer for Chicago Street Medicine.
The opinions expressed in this article are those of the author.