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Homeless health care: An ounce of prevention

Providing adequate health care to the homeless has always been difficult and costly. But the nonprofit Women of Means might have found a way of both improving the care homeless people receive while reducing the expense to hospitals and taxpayers. If the program continues to show results, other health care organizations should use it as a model.

The group focuses on giving elderly, homeless women preventive care outside of the hospital. The program has two goals: to provide the women with an unintimidating forum in which to talk to doctors, and to avoid having these women — many of whom have complex health troubles from years of living on the street — make costly trips to the emergency room.

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Commonwealth Care Alliance, a nonprofit health care organization that receives funding from Medicaid and Medicare, will pay approximately $500 a month per patient. This covers prescription medication, visits from doctors trained in trauma care, and other services. The monthly cost is significant, but it is a fraction of the emergency-room rate. Homeless people in Boston use the emergency room an average of four times a year. Inpatient care for those who are transferred to hospital beds can easily cost thousands of dollars. So preventive care leads to real savings down the line.

So far, the initiative seems to be working. According to the Women of Means founder, Dr. Roseanna Means, only a handful of the enrollees have visited the emergency room since April, and none have been admitted for inpatient care. Furthermore, none of the women treated have refused to take medicine prescribed to them — a clear sign that these women trust the doctors who have been assigned to them. Whether this sort of program can be scaled up in a cost efficient manner remains to be seen, but it shows real promise.

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