New report links housing to healthcare utilization and costs

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By Teagan Kuruna

Housing First is taking off around the country, with programs in cities as diverse as Iowa City, Seattle, and Camden. Housing First is an evidence-based model that ends homelessness by providing people with permanent supportive housing without barriers to entry such as sobriety or mental health recovery. At the Camden Coalition, high-quality, stable housing is central to our understanding of how to improve health. Our Housing First program identifies frequently-hospitalized and housing-unstable Camden residents and provides them with safe, dignified housing with extensive support so they can improve their health and manage chronic conditions.

Housing First isn’t just a quick fix or a feel-good initiative. Evidence is growing that when people who previously had housing instability are provided with permanent housing, their quality of life increases and avoidable acute care utilization decreases. Preliminary results from our Housing First program shows 60% reduction in ED visits and inpatient readmissions. A new report from the Urban Institute’s Health Policy Center provides further evidence for the positive relationship between housing and health.

Using data from the Survey of Income and Program Participation, a national survey designed to describe the overall economic circumstances of the US population, Urban Institute researchers investigated the relationships between food insecurity, housing hardship, and medical care utilization. They found that medical care utilization and out-of-pocket spending are higher for people who experience housing instability and housing quality hardships, even when taking into account differences in income, wealth, health insurance status, health status, and other characteristics.

People who experienced housing quality hardship, defined as living in a home that is in poor physical condition, were 11.2% more likely to have out-of-pocket spending, and their out-of-pocket spending was 16.9% higher than adults who did not have housing quality hardship. These individuals also had 14.9% more medical provider visits and were more likely to have a high rate of medical visits and to have prescription medications prescribed.

Housing insecurity, defined as late rent, mortgage, or utility payment(s) in the past 12 months and which the researchers used as a proxy for housing and utility stability, was also associated with higher medical utilization and costs. These individuals were 15.4% more likely to have any out-of-pocket spending and their spending was 28.5% higher than people whose housing was stable. This group was also more likely to have inpatient hospital admissions, had 22.1% more medical provider visits, and were 25.3% more likely to have a high number of outpatient visits. Prescription medication use was also higher in this group.

The Urban Institute researchers also found evidence that individuals experiencing food insecurity are more likely to have out-of-pocket spending on medical care. However, when housing insecurity is taken into account, the relationship between food insecurity and out-of-pocket spending weakens.

These findings confirm what Camden residents and the Camden Coalition care team experience every day: inadequate housing and poor health are inextricably linked. “We often see complex needs exacerbated by homelessness, housing instability, or homes that are in disrepair,” said Latonya Oliver, Clinical Manager of Social Work for Innovation Operations at the Camden Coalition. “Not having a safe place to live makes managing illness and social needs nearly impossible.”

The state of New Jersey initially began investing in Housing First in 2015 by providing housing vouchers, and again in 2016 with a $250,000 allocation to the Camden Coalition Housing First program. While Urban Institute’s analysis alone cannot determine if housing insecurity causes poor health, or vice versa, it does provide concrete evidence that there is a strong relationship between the two. And with the state of New Jersey’s continued investment of $500,000 in the Camden Coalition’s Housing First program for the 2019 fiscal year, we can see that the growing evidence has helped boost confidence in the value of Housing First for people with complex health and social needs who are experiencing housing instability.

Thank you to Dr. Kyle J. Caswell, lead author on the Urban Institute report “Food Insecurity, Housing Hardship, and Medical Care Utilization” discussed here, for his insights into the analysis.

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