Homeless Health Care Los Angeles

Full recipient ordinary-gift cost. E is audited all-function annual expense, not harm-reduction program expense. C=100000 normalization only. Benefits of other portfolio functions are unquantified and assigned zero in the conditional numerical model, with costs retained; not a claim of zero actual health.

Current direct service and historical rescues are in Los Angeles. Quantified pathway assumes all modeled health remains in California; migration is unmeasured, so a lower geographic fraction is a sensitivity rather than invented precision. Training spillovers are not quantified.

Candidate future response episodes N=C/E*R*lambda. Unique additional deaths prevented D=N*unique*rescue*delta*funding. L=sum(t=1..T)[utility*(1-m)^t/(1.03)^t]/1.03, finite years of health following an event at end of year 1. Q_CA=D*L*g. price10=10*C/Q_CA. This approximation requires unique-person accounting: all repeated rescues of one person share one survival/utility trajectory. More generally Q=sum_person integral_0^T[(S1*u1)-(S0*u0)]/(1.03)^t dt, with later alternative rescue and treatment in S0. Do not add separate lifetime credit for later repeat rescues.

C

100000 USD full recipient gift (judgment). Normalization only

E

25876205 USD FY2025 all-function expenses (observed). Original audit statement of activities and functional expenses; includes gross event expenses [audit25]

R

360 historical calendar2024 response episodes (observed). County says more than360; use360 floor, not current total or exact count [county]

lambda

1 current marginal response-density multiplier (judgment). Cautious unchanged absolute event benchmark against newer full cost; current growth could change either numerator or denominator [current-budget] [audit25] [county]

unique

0.7 unique-person credit fraction (judgment). Repeat response deduplication prior, not measured person count [wagner]

rescue

0.3 incremental timely-care fraction (judgment). Other witnesses/EMS often act; mobile team may reach unseen emergencies [street] [wagner]

delta

0.2 absolute mortality probability reduction (judgment). Assumed conditional episode fatality reduction, not observed survival fraction; causal value unmeasured

funding

0.3 gift-sensitive service fraction (judgment). Cautious substantial replacement discount in predominantly government-supported portfolio;90% government revenue does not mechanically imply10% additionality [audit25]

utility

0.7 quality of life while alive (judgment). Transfer assumption, no recipient utility series

m

0.06 annual mortality probability after rescue (judgment). Continuing high-risk prior; external cohort4.7deaths/100personyears provides context but is not this probability or population [survivors]

T

20 years finite horizon (judgment). Finite stress-test horizon, not forecast life expectancy

discount

0.03 annual health discount (judgment). Model convention

g

1 California fraction quantified health (judgment). Local encounters; migration unknown [home] [county]

other portfolio health

null QALYs per dollar (unknown). No health assigned from hygiene, housing, counseling, HIV/HCV testing or training without additionality/clinical bridge [services] [sbirt]

Cautious full-cost central: Cost: $100K; California QALYs: 0.10444189905615264; all-population QALYs: 0.10444189905615264. {"id":"central","lambda":1,"unique":0.7,"rescue":0.3,"delta":0.2,"funding":0.3,"utility":0.7,"m":0.06,"T":20,"L":5.958024670560652,"raw":1.3912395577326737,"D":0.01752961842743169,"q":0.10444189905615264,"price":9574701.427655535}; g=1; all other quantified branches=0

Higher response yield and causal leverage: Cost: $100K; California QALYs: 6.247439665911243; all-population QALYs: 6.247439665911243. {"id":"favorable","lambda":3,"unique":0.85,"rescue":0.6,"delta":0.35,"funding":0.8,"utility":0.8,"m":0.03,"T":30,"L":10.482157739408319,"raw":4.173718673198021,"D":0.5960070265326773,"q":6.247439665911243,"price":160065.57141422853}; g=1; all other quantified branches=0

Low marginal activity and heavy substitution: Cost: $100K; California QALYs: 0.00007790602551750972; all-population QALYs: 0.00007790602551750972. {"id":"pessimistic","lambda":0.25,"unique":0.3,"rescue":0.05,"delta":0.05,"funding":0.1,"utility":0.6,"m":0.1,"T":10,"L":2.9865367215204635,"raw":0.34780988943316843,"D":0.00002608574170748763,"q":0.00007790602551750972,"price":12835977619.924221}; g=1; all other quantified branches=0

No incremental delivery or rescue: Cost: $100K; California QALYs: 0; all-population QALYs: 0. funding=0 or rescue=0; no finite positive price

Counterfactual: Existing government contracts, other witnesses, paramedics and other naloxone programs continue. funding discounts whether a gift changes services; rescue discounts whether an otherwise similar episode receives additional timely care. delta is the causal fatality-risk difference conditional on that extra timely care, not the observed proportion surviving.

Attribution: No distinct naloxone, oxygen, CPR, outreach and paramedic lifetime claims for the same event. Unique-person adjustment is an explicit prior, not proof that registry deduplication was done. Public funding and other services are complements but not all attributable to private gifts.

Numerical model is judgment-based partial health accounting over full recipient cost. Calendar2024 reversal reporting and FY2025 expense periods are not matched; their ratio is a deliberately conservative benchmark, not observed cost per event. lambda explicitly captures current scale, program mix and marginal-versus-average productivity. No scenario is a probability-weighted expected value or a validated bound.

Sensitivity

• Central roughly$9.57m per ten California QALYs; favorable$160k; pessimistic$12.84bn. Extremes are joint stress tests approaching zero, not credible interval endpoints.
• At central L=5.958, $1M per ten requires0.16784 unique additional deaths prevented per$100k; $100k requires1.67841. Central0.01753 is below both.
• At other central assumptions, lambda must rise9.5747-fold to reach$1M per ten, or95.747-fold for$100k. Such improvements require evidence of a genuinely more productive marginal channel, not re-labeling the whole gift as harm-reduction restricted.
• Replacing auditedFY2025 cost with a$40m current budget while holding absolute response count constant lowers health by25.876205/40; actual new response volume could offset this, but is unknown.
• If half modeled health occurs outside California after migration, price doubles. No arbitrary geography discount is embedded.
• Other clinical or housing pathways could improve overall value. At central modeled0.10444Q/$100k, unquantified branches need an additional0.89556Q to reach$1M per ten or9.89556Q to reach$100k, without double-counting the same survival or disability.
• The entire portfolio is costed, but donated labor, partner resources, downstream care and medical savings are not comprehensively priced. A donor-cost estimate is not a societal-cost estimate.

Unresolved inputs

• Costed unfunded ordinary-gift allocation and current team/clinical capacity beyond government contracts.
• Matched current fiscal-year response volumes and expenses by service, including all-function overhead.
• Unique-person longitudinal response linkage, alternative rescuer timing and net episode mortality reduction.
• Clinical mix, health utility and additional completed treatment for non-overdose branches.
• Migration and location of health gains; actual donor replacement versus genuine expansion.
• Reconcile current$40m budget with2025audit and specify which new contracts/capacity explain growth.