1. How to get healthcare to pay for
housing?
Joshua D. Bamberger, MD, MPH
Associate Clinical Professor
Family and Community Medicine
University of California, San Francisco
San Francisco Department of Public Health
joshdbamberger@gmail.com

2. Why do we provide healthcare?

4. Mortality DAH vs Regular Care
1996-2003

5. Plaza High Utilizer Study
• 106 Chronically homeless adults
• Cost year before housing: $3,132,856
• Cost year after housing: $906,228
• Reduction in healthcare costs: $2,226,568
• Cost of program:
$1.1million/year
• Reduction in public
cost in first year:
$1.1 million

6. SF Health Dept’s Housing
• Direct Access to Housing- 1730 units in 43 buildings
– 6 buildings (N=510; 33%) with nurses
• Tailor housing to the needs of an individual
• Initially SRO, now new buildings
• Priority to people with multiple disabilities
• 7.6% HIV+
• Housing first, harm reduction, supportive housing

7. DAH Portfolio
•
253 286
604 678 704 704
878
0 0
177 247 339
689
1800
1600
1400
1200
1000
800
600
400
200
0
99-00 2001-2 2003-4 2005-6 2007-8 2009-
10
2011-
2015
New
Master-lease

16. HIV, Homeless and Survival
•

17. HIV, Homeless and Survival
•

18. 7.6
3.5
6.8
Death by Quality of Housing
3.9
5.3
%death
2.7
5.0
3.5
2.5
4.0
3.1
R² = 0.3889
Windsor Empress LeNain PBI CCR West Folsom Dore Plaza 149 Mason 990 Polk Mission Creek

19. 7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
Death rate Le Nain vs. Mission Creek 2006-2011
Death Rate/year
Le Nain death %
MCSC death %

20. Number of Homeless Veterans in 5 Communities with
600
500
400
300
200
100
0
Greater than 40% reduction 2010-2012
2010 2011 2012 2013 2014 2015
Hennepin
Lexington
Tacoma
Fort Worth
Birmingham
Measured
-------Projected
______

21. “It costs less to house homeless people
than to leave them on the streets and in
shelters.”
-Shaun Donovan
U.S. Secretary of Housing & Urban Development
The Daily Show, March 5, 2012

23. We know that housing..
• Improves health
• Reduces cost
• Improves quality of life
• Delivers on a moral imperative to care for the
people who cannot care for themselves

24. Tale of Two Patients

25. How can we have healthcare pay for
housing?

26. How to get healthcare to pay for
housing?
Joshua D. Bamberger, MD, MPH
Associate Clinical Professor
Family and Community Medicine
University of California, San Francisco
San Francisco Department of Public Health
joshdbamberger@gmail.com