Housing Quality Improvement and Health Care Utilization: A Regression Discontinuity Study

Area of Science:

• Environmental Health
• Health Services Research
• Public Health Policy

Background:

• Substandard low-income housing is linked to poor health outcomes.
• Healthcare payers are exploring housing quality interventions to reduce acute care costs.
• Evidence on the impact of housing quality improvements on health utilization is limited.

Purpose of the Study:

• To estimate the causal effect of mandated housing quality remediation on health utilization.
• To assess the short-term and longer-term impacts on acute care use and healthcare expenditures.
• To investigate the relationship between housing improvements and healthcare cost reduction strategies.

Main Methods:

• Utilized a regression discontinuity design to evaluate a large-scale policy in New York City.
• Analyzed health utilization metrics including acute care use and expenditures.
• Conducted exploratory longer-run event studies to examine delayed effects.

Main Results:

• No significant short-run impacts were found on acute care use or health expenditures.
• Exploratory analyses indicated potential moderate reductions (10%-15%) in emergency department visits 3-4 years post-intervention.
• Housing violation rates were halved, but overall building conditions remained poor, suggesting limited impact.

Conclusions:

• Mandated housing quality improvements did not yield immediate reductions in healthcare utilization or spending.
• The extent of housing remediation may be insufficient to translate into significant healthcare cost savings.
• Further research is needed to understand the threshold of housing quality improvement required for measurable health and economic benefits.