Interventions for Health: Why and How Health Care Systems Provide Programs to Benefit Unhoused Patients

Individuals experiencing homelessness have poorer health than housed individuals, while also utilizing more emergency department care and fewer preventive services. Several interventions - including permanent supportive housing, medical respite, and mobile medical clinics - are cost-effective means to improve health outcomes for homeless populations, yet few health systems have invested in such programs. This study aimed to determine the reasons some health systems initiated these interventions, and the early experience of those health systems that did. Quantitative analyses of health systems in 4 states with high levels of homelessness showed that interventions to improve the health of homeless populations were more common in larger hospitals, teaching hospitals, religious hospitals, network-affiliated hospitals, and hospitals in California. Interviews confirmed that health systems typically were moved to implement these interventions by more than 1 factor, including financial goals, mission-driven motives, a desire to improve care quality, and recognition of local need. Interviewees reported collaborations with community service providers, and some reported targeting services to specific subpopulations. Health systems reported success with some initiatives but noted that success was contingent on overcoming barriers including funding, opposition from the local community, challenges building true partnerships with service providers, and the reluctance of some homeless patients to receive services. Health systems may be encouraged by the results reported by early adopters who navigated these obstacles, while policy makers might consider incentivizing health systems to engage in these interventions by providing a dedicated funding stream.