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

Low-income housing is often of substandard quality. Health care payers like Medicaid and Medicare are piloting reimbursement for housing quality improvement with the rationale of reducing expenses from acute care use, but little is known about whether housing quality interventions can alter health utilization. I evaluate a large-scale policy mandating remediation of NYC's worst buildings in a regression discontinuity design to estimate the causal effect of housing improvements on health utilization. I do not find evidence of impacts on any metric of short-run acute care use or health expenditures, even among vulnerable subgroups. Exploratory longer-run event studies show some evidence of moderate (10%-15%) reductions in emergency department visits 3-4 years later but no evidence of impacts on expenditures. The policy succeeded at reducing housing violation rates in treated buildings by half. Yet, this only corresponded to a move from the 98th percentile to the 96th percentile of all buildings, underscoring the dire conditions tenants continue to live in-and suggesting one potential explanation for muted findings on health care use. The theory that housing quality interventions can directly translate to reductions in health use and spending may not be borne out empirically, particularly if interventions cannot completely address substandard conditions.