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Healthcare Utilization Among Children Receiving Permanent Supportive Housing
James C Bohnhoff1,2, Lingshu Xue3, Mara A G Hollander4
1Schools of Medicine.
Insights
Permanent supportive housing (PSH) increased dental visits for children. Younger children in PSH also saw fewer emergency department visits, highlighting PSH benefits for child health outcomes.
Area of Science:
- Public Health
- Health Services Research
- Pediatric Health
Background:
- Permanent supportive housing (PSH) provides housing and support to homeless individuals and families.
- Impacts of PSH on children's health are not well understood.
- This study investigates healthcare utilization among children in PSH.
Purpose of the Study:
- To examine changes in healthcare visits for children enrolled in PSH.
- To compare healthcare utilization in children receiving PSH versus those receiving non-PSH housing services.
- To assess the impact of PSH on pediatric health outcomes.
Main Methods:
- Analysis of Pennsylvania Medicaid administrative data (2011-2016).
- Matched 705 children in PSH with 3141 children in a comparison cohort.
- Used propensity score-weighted difference-in-differences (DID) to compare healthcare visits over 3 years pre- and post-PSH entry.
Main Results:
- Children in PSH had significantly more dental visits compared to the control group (DID: 12.70 visits per 1000 person-months).
- No significant differences in preventive medicine, hospitalizations, or overall emergency department (ED) visits were found.
- Younger children (≤5 years) in PSH showed a trend towards reduced ED visits (DID: -13.16 visits per 1000 person-months), though pre-entry trends differed.
Conclusions:
- PSH is associated with increased dental care utilization among children.
- Younger children entering PSH may benefit from reduced emergency department visits.
- Findings suggest PSH offers specific health advantages for children that policymakers should consider.
Background And Objectives:
Permanent supportive housing (PSH) integrates long-term housing and supports for families and individuals experiencing homelessness. Although PSH is frequently provided to families with children, little is known about the impacts of PSH among children. We examined changes in health care visits among children receiving PSH compared with similar children who did not receive PSH.
Methods:
We analyzed Pennsylvania Medicaid administrative data for children entering PSH between 2011 and 2016, matching to a comparison cohort with similar demographic and clinical characteristics who received non-PSH housing services. We conducted propensity score-weighted difference-in-differences (DID) analyses to compare changes in health care visits 3 years before and after children entered PSH versus changes in the comparison cohort.
Results:
We matched 705 children receiving PSH to 3141 in the comparison cohort. Over 3 years following PSH entry, dental visits among children entering PSH increased differentially relative to the comparison cohort (DID: 12.70 visits per 1000 person-months, 95% confidence interval: 3.72 to 21.67). We did not find differential changes in preventive medicine visits, hospitalizations, or emergency department (ED) visits overall. When stratified by age, children ≤5 years old at PSH entry experienced a greater decrease in ED visits relative to the comparison cohort (DID: -13.16 visits per 1000 person-months, 95% confidence interval: -26.23 to -0.10). However, emergency visit trends before PSH entry differed between the cohorts.
Conclusions:
Children in PSH had relatively greater increases in dental visits, and younger children entering PSH may have experienced relative reductions in ED visits. Policymakers should consider benefits to children when evaluating the overall value of PSH.
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