Abstract
Although growing evidence links residential evictions to health, little work has examined connections between eviction and healthcare utilization or access. In this study, eviction records are linked to Medicaid claims to estimate short-term associations between eviction and healthcare utilization, as well as Medicaid disenrollment. New York City eviction records from 2017 were linked to New York State Medicaid claims, with 1,300 evicted patients matched to 261,855 non-evicted patients with similar past healthcare utilization, demographics, and neighborhoods. Outcomes included patients' number of acute and ambulatory care visits, healthcare spending, Medicaid disenrollment, and pharmaceutical prescription fills during 6 months of follow-up. Coarsened exact matching was used to strengthen causal inference in observational data. Weighted generalized linear models were then fit, including censoring weights. Analyses were conducted in 2019-2021. Eviction was associated with 63% higher odds of losing Medicaid coverage (95% CI=1.38, 1.92, p<0.001), fewer pharmaceutical prescription fills (incidence rate ratio=0.68, 95% CI=0.52, 0.88, p=0.004), and lower odds of generating any healthcare spending (OR=0.72, 95% CI=0.61, 0.85, p<0.001). However, among patients who generated any spending, average spending was 20% higher for those evicted (95% CI=1.03, 1.40, p=0.017), such that evicted patients generated more spending on balance. Marginally significant estimates suggested associations with increased acute, and decreased ambulatory, care visits. Results suggest that eviction drives increased healthcare spending while disrupting healthcare access. Given previous research that Medicaid expansion lowered eviction rates, eviction and Medicaid disenrollment may operate cyclically, accumulating disadvantage. Preventing evictions may improve access to care and lower Medicaid costs.
Highlights
Growing evidence links residential evictions to health, little work has examined connections between eviction and healthcare utilization or access
Does the stress and deprivation caused by eviction lead to higher healthcare utilization? To date, only 1 study has examined whether healthcare visits of any kind spike after an eviction,[10] and evidence directly examining whether eviction interrupts healthcare access is scarce.[21]
Patient addresses in the claims file had been previously geocoded by the New York University Health Evaluation and Analytics Lab to the New York City (NYC) tax parcel system
Summary
Growing evidence links residential evictions to health, little work has examined connections between eviction and healthcare utilization or access. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California; 2Francois-Xavier Bagnoud Center for Health & Human Rights, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and 3NYU Wagner Graduate School of Public Service, New York, New York aGLS and JMF are co-first authors of this article. Chan School of Public Health, Boston, Massachusetts; and 3NYU Wagner Graduate School of Public Service, New York, New York aGLS and JMF are co-first authors of this article. Does eviction interrupt healthcare access, such as displacement away from known primary care providers,[18] difficulty refilling or storing prescriptions or adhering to their directed use,[13,19,20] or loss of health insurance coverage? Does the stress and deprivation caused by eviction lead to higher healthcare utilization? To date, only 1 study has examined whether healthcare visits of any kind spike after an eviction (focused on emergency room visits),[10] and evidence directly examining whether eviction interrupts healthcare access is scarce.[21]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
