{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T06:37:52Z","timestamp":1771396672492,"version":"3.50.1"},"reference-count":57,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Policy Anal Manage"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Low\u2010income 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\u2010scale 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\u2010run acute care use or health expenditures, even among vulnerable subgroups. Exploratory longer\u2010run event studies show some evidence of moderate (10%\u201315%) reductions in emergency department visits 3\u20134 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\u2014and 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.<\/jats:p>","DOI":"10.1002\/pam.70074","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T12:05:46Z","timestamp":1762862746000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Housing Quality Improvement and Health Care Utilization: A Regression Discontinuity Study"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9615-137X","authenticated-orcid":false,"given":"Kacie L.","family":"Dragan","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management Columbia University Mailman School of Public Health  New York New York USA"},{"name":"NYU Wagner Graduate School of Public Service  New York City New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301253"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1257\/app.20160404"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv189"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1416950111"},{"key":"e_1_2_9_6_1","unstructured":"Ashford G.2018. \u201cLeaks Mold and Rats: Why New York City Goes Easy on Its Worst Landlords.\u201dNew York Times December 26.https:\/\/www.nytimes.com\/2018\/12\/26\/nyregion\/nyc\u2010housing\u2010violations\u2010landlords\u2010tenants.html."},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2006.048462"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.0496"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2020.105990"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2018.2382"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2006.070847"},{"key":"e_1_2_9_12_1","doi-asserted-by":"crossref","unstructured":"Cattaneo M. D. N.Idrobo andR.Titiunik.2019.A Practical Introduction to Regression Discontinuity Designs: Foundations.Cambridge University Press.https:\/\/doi.org\/10.1017\/9781108684606.","DOI":"10.1017\/9781108684606"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.01008"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/pam.22051"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/14036096.2018.1538019"},{"key":"e_1_2_9_16_1","unstructured":"Divringi E. E.Wallace K.Wardrip andE.Nash.2019. \u201cMeasuring and Understanding Home Repair Costs.\u201dFederal Reserve Bank of Philadelphia and PolicyMap.https:\/\/www.philadelphiafed.org\/\u2010\/media\/frbp\/assets\/community\u2010development\/reports\/measuring\u2010and\u2010understanding\u2010home\u2010repair\u2010costs\/0919\u2010home\u2010repair\u2010costs\u2010national\u2010report.pdf."},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1081\u20101206(10)61012\u20105"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00767"},{"key":"e_1_2_9_19_1","unstructured":"Enterprise Community Partners. (2022. April 20). \u201cEnterprise Community Partners and New York City Health Department Launch Innovative \u2018Medicaid Together Improving Asthma Program\u2019.\u201dhttps:\/\/web.archive.org\/web\/20240918175026\/https:\/\/www.enterprisecommunity.org\/blog\/enterprise\u2010community\u2010partners\u2010and\u2010new\u2010york\u2010city\u2010health\u2010department\u2010launch\u2010innovative\u2010medicaid."},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.22.0400"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m4571"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2022.101767"},{"key":"e_1_2_9_23_1","unstructured":"Glied S.2020. \u201cBetter Housing Improves People's Lives\u2014Health Benefits Should Be Seen as a Bonus.\u201dMilbank Quarterly Opinion. Published November 12.https:\/\/www.milbank.org\/quarterly\/opinions\/better\u2010housing\u2010improves\u2010peoples\u2010lives\u2010health\u2010benefits\u2010should\u2010be\u2010seen\u2010as\u2010a\u2010bonus\/."},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.3445"},{"key":"e_1_2_9_25_1","unstructured":"Hostetter M. andS.Klein.2020. \u201cCHRONIC Care Act Prompts Some Medicare Advantage Plans to Incorporate Social Services.\u201dCommonwealth Fund. 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Published July 12.https:\/\/fphnyc.org\/blog\/battling\u2010pest\u2010related\u2010pediatric\u2010asthma\/."},{"key":"e_1_2_9_35_1","unstructured":"Livingston S.2019. \u201cMedicare Advantage Insurers Tout Pest Control Acupuncture Among New 2020 Benefits.\u201dModern Healthcare. Published October 4.https:\/\/www.modernhealthcare.com\/insurance\/medicare\u2010advantage\u2010plans\u2010tout\u2010pest\u2010control\u2010acupuncture\u2010among\u2010new\u2010benefits."},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41030\u2010022\u201000207\u20107"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2019.05.021"},{"key":"e_1_2_9_38_1","unstructured":"NYC Department of City Planning.2022. PLUTO (Version 22v2).https:\/\/www.nyc.gov\/site\/planning\/data\u2010maps\/open\u2010data\/dwn\u2010pluto\u2010mappluto.page."},{"key":"e_1_2_9_39_1","unstructured":"NYC Department of Housing Preservation and Development.2018. \u201cAEP Year 11 Report to the City Council.\u201dhttps:\/\/www.nyc.gov\/assets\/hpd\/downloads\/pdfs\/services\/AEP\u2010year11\u2010report.pdf."},{"key":"e_1_2_9_40_1","unstructured":"NYC Department of Housing Preservation and Development.2020. \u201cAEP Year 13 Report to the City Council.\u201dhttps:\/\/www.nyc.gov\/assets\/hpd\/downloads\/pdfs\/services\/AEP\u2010year13\u2010report.pdf."},{"key":"e_1_2_9_41_1","unstructured":"NYC Department of Housing Preservation and Development.2022a. \u201cAEP Year 15 Report to the City Council.\u201dhttps:\/\/www.nyc.gov\/assets\/hpd\/downloads\/pdfs\/services\/AEP\u2010year15\u2010report.pdf."},{"key":"e_1_2_9_42_1","unstructured":"NYC Department of Housing Preservation and Development.2022b. \u201cAlternative Enforcement Program (AEP).\u201dhttps:\/\/www.nyc.gov\/site\/hpd\/services\u2010and\u2010information\/alternative\u2010enforcement\u2010program\u2010aep.page."},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2022.102898"},{"key":"e_1_2_9_44_1","unstructured":"NYC Department of Health and Mental Hygiene.2023. \u201cHousing Data for NYC. Environment & Health Data Portal.\u201dhttps:\/\/a816\u2010dohbesp.nyc.gov\/IndicatorPublic\/data\u2010explorer\/housing\u2010maintenance\/?id=45#display=summary."},{"key":"e_1_2_9_45_1","unstructured":"Office of the Mayor.2024. \u201cMayor Adams Announces Record Number of Affordable Homes Created in 2023.\u201d Official Website of the City of New York. 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U.S. GAO.https:\/\/www.gao.gov\/assets\/gao\u201020\u2010427.pdf."},{"key":"e_1_2_9_58_1","unstructured":"Zhang S.2021. \u201cDoctors Might Have Been Focusing on the Wrong Asthma Triggers.\u201dAtlantic. Published July 9.https:\/\/www.theatlantic.com\/health\/archive\/2021\/07\/the\u2010pandemic\u2010drove\u2010asthma\u2010attacks\u2010down\u2010why\/619396\/."}],"container-title":["Journal of Policy Analysis and Management"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pam.70074","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pam.70074","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pam.70074","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T05:53:25Z","timestamp":1771394005000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pam.70074"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,11]]},"references-count":57,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1002\/pam.70074"],"URL":"https:\/\/doi.org\/10.1002\/pam.70074","archive":["Portico"],"relation":{},"ISSN":["0276-8739","1520-6688"],"issn-type":[{"value":"0276-8739","type":"print"},{"value":"1520-6688","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,11]]},"assertion":[{"value":"2024-11-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70074"}}