Children of families who receive housing vouchers had lower hospital spending into adulthood

Young children whose households participated in a housing voucher program were admitted to the hospital fewer times and incurred lower hospital costs over the course of two decades than did children whose households did not receive the rental support, according to a new study published last week by Johns Hopkins researchers.

The study, published in JAMA, used data collected by the U.S. Department of Housing and Urban Development in an experimental program, the Moving to Opportunity for Fair Housing Demonstration Project, which gave low-income families living in public housing the chance to move to areas with lower poverty through a housing voucher. Researchers from the schools of Public Health, Medicine, and Arts and Sciences linked households with insurance and hospital data to examine hospitalizations over time. The study's findings are potentially relevant to the roughly 4 million children who live in low-income households and whose families receive Housing and Urban Development assistance, the researchers say.

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Smart moves

Johns Hopkins sociologist Stefanie DeLuca is involved in an ambitious experiment designed to place housing voucher recipients in areas of high opportunity. More than a year into the pilot program, the early findings are striking.

The study found that children age 12 or younger who lived in a household that received a housing voucher had 27% lower spending on hospitalizations—nearly $200 per year—than children whose households did not receive a housing voucher. During a follow-up period after enrollment in the program, children whose families received housing vouchers were also found to be hospitalized 18% less than children whose families did not receive vouchers.

Families who used the vouchers to move to lower-poverty neighborhoods were found to have lower health care spending and fewer hospital admissions for children younger than 12. The study did not find comparable savings or fewer hospitalizations in older children or in adults whose households received housing vouchers to move to lower-poverty neighborhoods.

"While the long-term financial benefits of helping young children move out of high-poverty neighborhoods has increasingly been recognized, these findings underscore the potentially significant health impacts," says lead author Craig Evan Pollack, an associate professor in the Bloomberg School's Department of Health Policy and Management. "The fact that we see lower hospital spending over such a long follow-up period suggests the enduring importance of helping young children live in opportunity neighborhoods."

Stefanie A. DeLuca, a professor of sociology and social policy at Johns Hopkins, says the findings indicate how housing policies can have a direct impact on poverty and health.

"Through effective housing policy, we can improve the long-term social mobility and health of low-income families with children, and what this study shows is that you can also reduce health care costs while you're doing it," DeLuca says. "This exciting interdivisional, interdisciplinary project—across the schools of Public Health, Medicine, and Arts and Sciences—really showcases the benefits of being at Hopkins."

The Moving to Opportunity for Fair Housing Demonstration Project enrolled 4,604 families living in public housing developments or in high-poverty neighborhoods in Baltimore, Boston, Chicago, Los Angeles, and New York from 1994 to 1998. Families were randomly selected to three groups: one received a housing voucher to use in a low-poverty neighborhood, another received a housing voucher without neighborhood restrictions, and a control group received no voucher.

Researchers linked participants to hospital discharge and Medicaid data to evaluate the association of housing vouchers with hospital utilization and spending among children and adults from 1995 to 2015, depending on city and health records. The study focused on the number of annual hospitalizations, the number of inpatient hospital days per year, and total annual hospital spending for adults, children under 18, and children under 13.

Researchers found that children under 18 whose family received a housing voucher had an 18% reduction in annual hospital spending compared to children who did not receive a housing voucher ($633 compared to $785). They also found that there was a 15% lower rate of hospitalizations for children under 18 who received a housing voucher. For families that used the voucher to move, every 10 percentage points a family reduced its neighborhood poverty—e.g., moving from a neighborhood where 40% of the households lived below the poverty line to one with 30% below the poverty line—they spent an average of $152 less per year in the hospital on children under 18.

"Reducing the level of poverty that children are exposed to in the neighborhoods where they grow up may be one way to lower health care costs," Pollack says. "Housing policies should take into account the potential implications for health care use over the long run."