It is important to bear in mind that the $27,170,143 cost figure is not for all of the 115 sampled non-governmental agencies, but only for the 32 reporting agencies. It is thus a conservative estimate of agency costs, although as we noted above, the largest providers of services for the homeless population are included. As will be seen in Table 11, we use the total budget information provided by the housing agencies that returned questionnaires to estimate the total cost of servicing this population across all nongovernmental housing agencies.
Hospitals and Emergency Departments As of 2015, there were 24 hospitals with emergency departments (ERs) within the county. Table 10 shows the estimated costs accrued to the hospitals for both ER and inpatient encounters with homeless individuals for 2015. The estimated total for emergency department encounters is $19,245,600; for inpatient encounters it is $57,319,434. The total for the two estimates combined is $76,565,034. The data on which these estimates are based come from two major sources: CalOptima, through the Hospital Association of Southern California, for the ER data; and OSHPD (Office of Statewide Health Planning and Development), via the Orange County Health Care Agency, for the inpatient data. CalOptima ER Data CalOptima is a public agency that provides health
care coverage for Orange County residents who are eligible for Medi-Cal. It contracts with health networks, physician specialists and hospitals to provide health care to its members, many of whom are indigent adults with incomes between 138% and 200% of the Federal Poverty Level ($11,770 for one person in 2015; $15,930 for two persons; and $20,090 for three persons) and who have chronic health conditions, behavioral health issues and non-health related challenges, such as homelessness, resulting in increased ER utilization due to lack of primary/preventive care access. The CalOptima ER data we assessed represented only around a third of the health network reporting. Consequently, our cost estimate is calculated by multiplying the CalOptima ER data by a factor of 3.3. Thus, the CalOptima data shows that 3,560 homeless individuals had 6,480 ER visits, averaging close to two per client, across 20 OC hospitals, at an average cost of approximately $900 per person, which we multiplied times 3.3, yielding the estimated cost for ER encounters of $19,245,600. OSHPD Inpatient Data The hospitalization data, lagging a year (2014), reveal that 1,609 homeless individuals were hospitalized for an average of 10.4 days at an average charge of $35,624.28. Multiplying the number of hospitalizations times the average charge yields the estimated hospitalization cost of $57,319,434. In addition to the total hospitalization charge, the demographic characteristics of the homeless
Table 10. Cost Findings on Orange County Hospital ER and Inpatient Charges Agency/Hospital
Emergency Department
Inpatient
Subtotal
Cal Optima via Hospital Association of Southern California
6,480 x $900 x 3.3 = $19,245,600
—
$19,245,600
OSPHD files via OC Health Care Agency
—
1,609 x $35,624.28 = $57,319,434
$57,319,434
TOTAL
$76,565,034
Note: Only one major OC hospital provided detailed cost data. The above are aggregated figures across all OC hospitals and emergency rooms.
f RETURN TO CONTENTS
24 | Cost Comparisons Across Institutional Sectors
Homelessness in Orange County: The Costs to Our Community
