Children who moved out of high-poverty neighborhoods visited the hospital significantly less, according to a new study.
Children whose families received a housing voucher to move to low-poverty neighborhoods were admitted to the hospital nearly 16% less than families who remained in impoverished areas, curbing annual inpatient spending by 24%, according to a new analysis of 4,604 families tracked across an average of 11 years. The results for adults were insignificant, researchers found.
"This research further spotlights the importance of housing and neighborhood context for children as they grow up," said Dr. Craig Pollack, lead author of the study and an associate professor of medicine at the Johns Hopkins University School of Medicine. "It helps us consider the long-term ramifications for kids."
Researchers paired data from the U.S. Department of Housing and Urban Development's Moving to Opportunity for Fair Housing Demonstration Program, a randomized social experiment across five cities, with state claims data. Children who moved to better areas only had 6.3 hospitalizations per 100-person years compared to 7.3 for their cohorts. Annual hospital spending was $633 compared to $785.
The results for younger children and girls were more pronounced than older children and boys. A related study found that children who moved out of high-poverty area saw earnings jump 14% and college attendance rise 16%.
Improved housing conditions may not have had similar impacts on adults because the study only looked at hospitalizations and did not track outpatient utilization, Pollack said. It also might take longer for changes in adult-related hospital spending to materialize, he said.
"There is increasing interest from healthcare systems in how to best address these needs, and housing mobility programs are an important option," Pollack said. "The cost of helping families move to low-poverty neighborhoods may be feasible for health systems, at the same time they need to focus on other place-based initiatives."
Housing initiatives have been gaining traction with health systems across the country as they look to curb costs and make systemic improvements to boost the health of broader populations. But investments are still relatively limited.
The three biggest impediments to investing in housing, nutrition and other basic needs are insufficient staffing, limited data to measure impacts and financial burden, according to a recent survey from Reaction Data.
Many don't know where to start and it's difficult to dedicate time and money to programs that don't produce visible, short-term results, health system administrators said in the survey.
"Payers need to take a long view," Pollack said. "Some of the upfront costs would potentially be justified in terms of spending reduction over the long term."
Health systems have had success with mobile markets, school gardening projects and other food-related initiatives as well as rural transportation programs, they said.
Housing is one resource that will incrementally improve healthcare outcomes, said Lesley Cottrell, professor of pediatrics at West Virginia University and director of its center for excellence in disabilities.
"It's hard to be compliant with treatment regiments when you have bigger issues like housing," she said. "Patients will be more involved in their own medical care because they can attend to those items. Although, housing alone won't resolve it."
Transportation, schools, infrastructure and other elements will factor into their health, Cottrell added.
Last month, 14 of the country's largest hospital systems pledged to invest more than $700 million in community-based initiatives, including housing, that aim to close outcome disparities.
Enterprise Community Partners' Health Begins with Home initiative will deploy $250 million over five years to facilitate cross-sector collaboration to integrate affordable housing, community development and healthcare.
Kaiser Permanente has teamed up with Enterprise to build thousands of affordable homes across the Oakland, Calif.-based integrated health system's network. Developers look to link housing with healthcare services related to chronic diseases and mental health, among others.
Although they are smaller than Kaiser's $200 million collective investment, Boston Medical Center and Bon Secours Mercy Health also invested in housing. Bon Secours Mercy Health offers job training, early childhood development, financial education, fresh produce as well as affordable homes, the majority of which are for seniors and those with disabilities.
Meanwhile, the CMS is exploring ways to pay for housing, healthy food and other social services.