Housing Quality Improvement and Health Care Utilization: A Regression Discontinuity Study
Journal of Policy Analysis and Management · 2026 · Kacie L. Dragan
中文摘要
低收入住房的质量往往不达标。Medicaid 和 Medicare 等医疗支付方正试点对住房质量改善进行报销,其理由是减少急症医疗使用带来的开支,但住房质量干预能否改变医疗利用,目前所知甚少。我在断点回归设计中评估一项要求整治纽约市最差建筑的大规模政策,以估计住房改善对医疗利用的因果效应。我没有发现其对短期急症医疗使用或医疗支出的任何指标产生影响的证据,即使在脆弱亚群体中亦是如此。探索性的更长期事件研究显示,有一定证据表明3-4年后急诊就诊次数出现中等幅度(10%-15%)的下降,但没有证据表明对支出产生影响。该政策成功地将受处理建筑的住房违规率降低了一半。然而,这仅相当于在全部建筑中从第98百分位移动到第96百分位,凸显了租户依然生活在恶劣的条件之中——这也为医疗使用方面不显著的发现提供了一种潜在解释。住房质量干预能够直接转化为医疗使用和支出减少这一理论,可能在经验上得不到证实,尤其是在干预无法完全解决不达标条件的情况下。
Abstract
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.