HEALTH-CARE UTILIZATION AND COSTS AFTER ENTRY INTO AN OUTREACH PROGRAM FOR HOMELESS MENTALLY-ILL VETERANS

Objective: This study evaluated the impact of a Department of Veterans Affairs outreach and residential treatment program for homeless menta lly ill veterans on utilization and cost of health care services provi ded by the VA. Methods: Veterans at nine program sites (N = 1,748) wer e assessed with a standard intake instrument. Services provided by the outreach program were documented in quarterly clinical reports and in residential treatment discharge summaries. Data on nonprogram VA heal th service utilization and health care costs were obtained from nation al VA data bases. Changes in use of services and cost of services from the year before initial contact with the program to the year after we re analyzed by t test. Multivariate analyses were used to examine the relationship of these changes to indicators of Clinical need and to pa rticipation in the outreach program. Results: Although utilization of inpatient service did not increase after veterans' initial contact wit h the program, use of domiciliary and outpatient services increased su bstantially. Total annual costs to the VA also increased by 35 percent , from $6,414 to $8,699 per veteran per year. Both clinical need and p articipation in the program were associated with increased use of heal th services and increased cost. Veterans with concomitant psychiatric and substance abuse problems used fewer health care services than othe rs. Conclusions: Specialized programs to improve the access of homeles s mentally ill persons to health care services appear to be effective, but costly. Dually diagnosed persons seem especially difficult to eng age in treatment.