Housing Quality Improvement and Health Care Utilization
A Regression Discontinuity Study
Bibliographic Data
| ID | 11684747 |
|---|---|
| Authors | Kacie L Dragan (0000-0001-9615-137X, Department of Health Policy and Management Columbia University Mailman School of Public Health New York New York USA, corresponding author) |
| Year | 2025 |
| Volume | 45 |
| Issue | 1 |
| Publication date | 2025-11-11 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Journal of Policy Analysis and Management (JOURNAL) |
| Journal identifiers | ISSN: 0276-8739 • E-ISSN: 1520-6688 |
| Publisher | Wiley (PUBLISHER • GB) |
| DOI | 10.1002/pam.70074 |
| OpenAlex | W7104607434 |
| Language | EN |
| References cited | 38 |
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
Health care · Health care quality · Medicaid · Psychological intervention · Quality (philosophy · Quality management · Regression discontinuity design · Reimbursement · Geriatric Care and Nursing Homes · Health disparities and outcomes · Homelessness and Social Issues
A Practical Introduction to Regression Discontinuity Designs
Effect of insulating existing houses on health inequality
PM 2.5 polluters disproportionately and systemically affect people of color in the United States
Bias in smart city governance
Health Systems and Social Services—A Bridge Too Far
Understanding the mechanisms linking holistic housing renovations to health and well-being of adults in disadvantaged neighbourhoods
Tenants’ Responses to Substandard Housing
Do health trajectories predict neighborhood outcomes? Evidence of health selection in a diverse sample of U.S. adults
Where I live
Understanding the mental health impacts of poor quality private-rented housing during the UK's first Covid-19 lockdown
The Internal and External Validity of the Regression Discontinuity Design
The Watcombe Housing Study
Assessing housing quality and its impact on health, safety and sustainability
The Breathe-Easy Home
Environmental Conditions in Low-Income Urban Housing
Housing and Health
| Citation velocity | historical |
|---|---|
| Highly cited | No |