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THREAD In @JAMAInternalMed we explore why hospitals are investing billions of $ into housing.
On the surface, these #SDOH programs are promising. But they might also be a red flag about the growing power of hospitals.
to @AdamLBeckman & @JMichaelMcW
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2768657
On the surface, these #SDOH programs are promising. But they might also be a red flag about the growing power of hospitals.
to @AdamLBeckman & @JMichaelMcW https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2768657
(2/n) From 2017 to 2019, health systems spent $2.5B to address social determinants of health - $1.6B on housing ( @leorahorwitzmd in @Health_Affairs)
Homelessness is a serious national problem, but why are hospitals spending their $ to address it?
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.01246
Homelessness is a serious national problem, but why are hospitals spending their $ to address it?
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.01246
(3/n) First, the skeptic's point of view. Maybe hospitals are saving money by investing in housing because it helps turn over beds faster, it's a cheaper way to meet community benefit requirement for tax exemption, or it reduces medical costs for patients they are accountable for
(4/n) BUT...community benefit requirement is weakly enforced, transitional units may only benefit a small subset of patients, and evidence suggests that housing patients who are homeless rarely reduces medical costs enough to cover the housing costs
this is likely a net expense.
this is likely a net expense.
(5/n) That brings us to the optimist's point of view: hospitals are trying to do the right thing for their patients. But why do hospitals have the resources to do this?
Because high hospital prices act as a tax - they transfer resources from patients & govts to large hospitals.
Because high hospital prices act as a tax - they transfer resources from patients & govts to large hospitals.
(6/n) These big nonprofit hospitals can then dedicate some of the surplus from high prices to charitable spending - in most cases, this charity amounts to less than the value they get from tax exemptions (so the nonprofit tax exemption can be profitable). https://journals.sagepub.com/doi/full/10.1177/0046958017751970
(7/n) Growing health care expenditures - driven in part by increasing hospital prices - have crowded out spending on affordable housing, for both governments and patients
(8/8) What if these hospital surplus dollars were, instead, back in the hands of patients and governments? Might there be fewer homeless patients?
See our paper for a few ways to help us begin to answer these troubling questions. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2768657
See our paper for a few ways to help us begin to answer these troubling questions. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2768657
