Should Physicians ‘Prescribe’ Housing for the Homeless?

Originally published on Medscape.

Megan Sandel, MD, MPH, a pediatrician at Boston Medical Center (BMC) in Massachusetts, told Medscape Medical News, “I do believe that housing is a prescription for health. I believe, though, that the [entity that needs] to stock the pharmacy for housing is really the federal government.”

She said creating partnerships across federal, state, and local lines will be crucial in producing more affordable housing.

“While maybe for a subset of very high-cost patients, it may make sense for a hospital or health insurer to pay for housing, I think in the long run for most people that prescription is going to have to come from public–private partnerships,” she said.

Boston Medical, she said, is piloting on a small scale a housing prescription program where it pairs a housing program through the Boston Housing Authority, a public housing agency, with services paid for by BMC. They are focusing on medically complex families and high-cost, high-need adults. Some of the data will be detailed in the journal Health Affairs in April, Sandel said.

“That pairing of a housing dollar with a health dollar for supportive services, I think, is a model that could be scaled,” she said.

However, Sandel pointed out, “Only 1 out of 4 people eligible for affordable housing are getting it. We need to stock the pharmacy with a lot more housing to have healthier communities.”

She emphasized that there is a nuance with housing in that “first and foremost it gives you a home. The magic medical property of it is that it gives you a home AND makes you healthier. AND it makes your kids do better in school. AND it helps you keep a job. It’s the ‘AND’ that’s important.”

Some see housing prescriptions as needing to pay for themselves by reducing healthcare costs, but that misses the true scope, Sandel said.

“Prescriptions never have to show they save money, but just that they improve health. Homes pass that test. But it’s not that we should put that on a healthcare dollar, we should put it on a ‘public-good’ dollar, an infrastructure dollar,” she said.

“The solution isn’t for doctors to write prescriptions without the federal government getting back into building the affordable housing business,” Sandel emphasized.