Hospital Encounters for Persons Experiencing Homelessness in California: Patient Demographics by Facility, 2023-2024
From 2023 to 2024, persons experiencing homelessness (PEH) accounted for 984,506 hospital encounters, representing 3.0% of all encounters in California hospitals.
Why Publish Hospital Encounters for Persons Experiencing Homelessness in California?
Hospital encounters for patients experiencing homelessness (PEH) is an important indicator of hospital and health system utilization. The Hospital Encounters for Persons Experiencing Homelessness in California: Patient Demographics by Facility 2023-2024 visualization shows the percent of encounters [inpatient (IP) hospitalizations or emergency department (ED) visits] for both “Homeless” and “Non-Homeless” patients, which enables the user to identify differences between the two groups. The statewide percentages are provided in the hover over function (Tooltip) for each of the bar charts to compare custom selections to the related statewide percentages.
For each demographic topic—Age Group, Race/Ethnicity, Assigned Sex at Birth, and Expected Payer—the user can view graphs for a single hospital or multiple hospitals. The visualizations can also be filtered by county, healthcare system, hospital ownership, licensed bed size, urban/rural designation and Health Professional Shortage Area – Primary Care and Mental Health.
A Health Professional Shortage Area (HPSA) is a geographic area, population group, or healthcare facility that has been designated by the Health Resources and Services Administration (HRSA) as having a shortage of health professionals.
Key Findings
- From 2023-2024, PEH accounted for 984,506 hospital encounters in California (277,526 IP hospitalizations and 706,980 ED visits).
- The “19 to 39” age group (32.4%) combined with the “40 to 59” age group (42.0%) make up 74.4% of IP hospitalizations for PEH versus 38% of Non-Homeless IP hospitalizations for those same combined age groups.
- In the ED setting, the percent of visits for Black PEH (22.9%) is approximately twice the percent of visits for Non-Homeless Black (9.2%).
- In the IP setting, the percent of hospitalizations for Hispanic PEH (29.6%) and Asian/Pacific Islander PEH (2.5%) are considerably lower than the percent of hospitalizations for Non-Homeless Hispanic (35.3%) and Non-Homeless Asian/Pacific Islander (10.3%).
- For all settings, males comprise over 70% of encounters for PEH, but only about 45.3% of the Non-Homeless encounters.
- Medi-Cal is the expected payer for the majority of IP hospitalizations for PEH (65.0%), whereas Medicare (37.3%), Medi-Cal (30.2%), Private Health Insurance (27.5%), Other Government (2.7%), Self-Pay or Uninsured (1.4%), and All Other Payers (0.9%) are more evenly represented among Non-Homeless IP hospitalizations.
Visualization
How HCAI Created This Product
- This product was created using the 2023 and 2024 Patient Discharge Data and Emergency Department Data.
- The homelessness indicator for 2023-2024 data was defined by the presence of the ICD-10-CM diagnosis code “Z59.0” in any diagnosis position and/or a “Homelessness Indicator”.
- The County is based on the location of the treating hospital.
- Urban and Rural designations are determined based on the Medical Service Study Area Designation (MSSA) framework. MSSAs were developed using combinations of census-defined geographic units, established following General Rules issued by a statutory commission. An MSSA is designated as “Rural” if it has a population density of fewer than 250 persons per square mile and contains no census-defined place with a population exceeding 50,000. “Frontier” MSSAs are rural MSSAs with a population density of fewer than 11 persons per square mile. All other MSSAs are classified as “Urban.” This framework is used by HCAI to support consistent health planning.
Glossary
Expected Payer: The payer type that was expected to pay the greatest share of the patient’s bill at the time of discharge, not the payer type that actually paid.
| Payer Grouping | Inpatient Discharges | Emergency Department Visits |
|---|---|---|
| Medicare: A federal health insurance program funded by the Centers for Medicare & Medicaid Services (CMS) under the Social Security Amendments of 1965 that provides healthcare benefits to those aged 65 years and over and to disabled beneficiaries of any age. Includes Medicare Advantage and Medicare Fee-for-Service (Traditional Medicare). | Medicare | Medicare Part A, Medicare Part B, and Health Maintenance Organization (HMO) Medicare Risk |
| Medi-Cal: A public health insurance program that provides free or low-cost medical services and healthcare benefits to low-income individuals, financed from state and federal funds; California’s version of Medicaid. Includes Medi-Cal Managed Care and Medi-Cal Fee-for-Service. | Medi-Cal | Medicaid (Medi-Cal) |
| Private Health Insurance: Coverage by private, non-profit or commercial health plans or through organizations. Includes individual coverage purchased through Covered California, and organized charity payers (e.g., March of Dimes, Shriners). | Private Coverage | Preferred Provider Organization (PPO), Point of Service (POS), Exclusive Provider Organization (EPO), Blue Cross / Blue Shield, Commercial Insurance Company, and Health Maintenance Organization |
| Other Government: Public insurance programs other than Medicare or Medi-Cal, including federal, state, county and veteran-specific programs. | County Indigent, Other Government | CHAMPUS (TRICARE), Other Federal Program, Title V, Veterans Affairs Plan, and Other Non-Federal Programs |
| Self-Pay or Uninsured: Coverage where the greatest share of the patient’s bill is not expected to be paid by any other form of insurance or health plan. Includes uninsured patients, as well as instances when insurance does not cover the treatment, or the patient would like to keep the medical procedure private. | Other Indigent, Self-Pay | Self-Pay |
| All Other Payers: Includes payers not categorized elsewhere: Workers’ Compensation, Automobile Medical, disability insurance, third-party payment not included in any other category or stays for which no payment will be required by the facility (e.g. courtesy patients). | Workers’ Compensation, Other Payer | Automobile Medical, Disability, Workers’ Compensation Health Claim, Other |
Additional Information
Topic: Healthcare Utilization
Source Link: Healthcare Utilization – Patient Level Administrative Data
Citation: HCAI – Patient Discharge Data, Emergency Department Data – Hospital Encounters for Persons Experiencing Homelessness in California: Patient Demographics by Facility, 2023-2024
Temporal Coverage: 2023-2024
Spatial/Geographic Coverage: Statewide
Frequency: Annually