The San Francisco Department of Public Health Direct Access to Housing (DAH) program offers supportive housing facilities that provide long-term stable housing for homeless individuals. We evaluated the costs and benefits of supportive housing through an analysis of health care utilization by DAH-eligible individuals and overall costs of public services. The project consisted of three parts:

  • To compare health service utilization between homeless individuals placed in the DAH program to a control group drawn from eligible individuals who were not placed. The intervention includes the provision of supportive housing and site-specific, housing-based social and clinical services. Housing status and health services utilization were compared for the 24 months before and after the intervention, controlling for prior utilization and social factors assessed at referral.
  • To compare the public sector costs for homeless individuals with and without supportive housing. Cost data for all accessible health care and preventive health services were accessed using administrative data from the San Francisco General Hospital and clinic network, mental health system and emergency medical services system. Cost from a municipal government budget perspective were also included, such as costs for direct aide, shelter services, and the criminal justice system.
  • To inform public health and housing policy on cost-effective responses to homelessness.