HUD Housing Assistance Linked to Improved Access to Care

Researchers and policy makers have recognized the importance of safe and stable housing in achieving better health outcomes, but a new study adds evidence that receiving housing assistance from programs administered by the federal Department of Housing and Urban Development (HUD) is associated with expanded healthcare access.

HUD provides housing assistance via 3 mechanisms: Housing Choice Voucher programs, public housing for low-income families, and Multifamily Housing Programs. A prior study funded by HUD compared the effects of different assistance programs on health and access to care, but did not investigate their impact compared with not receiving any aid.

The study, published in Health Affairs, aims to assess whether nondisabled adults receiving HUD housing assistance reported better healthcare access than those not receiving such aid. Using HUD administrative data linked to National Health Information Survey (NHIS) answers, researchers measured respondents’ access to care by their reported insurance status, usual source of care, and having delayed or avoided getting needed care due to cost.

The HUD data helped the researchers determine which of the respondents had received housing assistance at the time of the NHIS interview, deemed “current recipients.” Those who had begun receiving assistance within the 2 years after the interview, or “future recipients,” served as the control group, in order to minimize the risk of selection bias from comparing people who seek aid to those who do not apply.

After adjusting for covariates like demographic information, census region, and income as a percentage of the federal poverty level, the researchers found that 31.8% of current housing assistance recipients were uninsured, a rate significantly lower than the 37.2% of those who had not yet received aid. There were no significant differences between the 2 groups in the proportion without a usual source of care.

The current recipients were also less likely to report that they had an unmet need for medical, mental health, or dental care or prescription drugs due to cost in the previous year, at 40%, compared with 47.8% of the future recipients. Even after adjusting for insurance coverage status, the current recipients still had lower rates of unmet need due to cost than the future recipients.

Further analyses of the various types of assistance found just 1 significant difference; adults in public housing at the time of the interview were significantly less likely to report unmet need due to cost than those who later moved to public housing, by a margin of over 10 percentage points.

The researchers suggested that the improved measures of healthcare access among current recipients of HUD housing assistance could be linked to the competing demands theory, which states that gaining stable housing will allow people to concentrate their attention, as well as their financial resources, on their healthcare needs. If public and subsidized housing buildings are near other social services like public health clinics, there may also be a “gateway effect” that contributes to expanded access. The authors also noted the existence of some outreach initiatives conducted by public housing programs that aim to educate tenants about their healthcare options.

As the current study had demonstrated an association between housing assistance and expanded access to care, the study authors suggested that further research could assess the effect of housing assistance on healthcare utilization, outcomes, and costs.

“Future housing policy and program evaluations, combined with findings from this study, could aid policy makers by providing evidence of the potential health-related impacts and cost-effectiveness of housing policies and programs,” they concluded.