In the wake of a crisis: Caught between housing and healthcare

Monica Hernandez; Rebeca Wong; Xiaoying Yu; Neil Mehta

doi:10.1016/j.ssmph.2023.101453

In the wake of a crisis: Caught between housing and healthcare

SSM Popul Health. 2023 Jun 13:23:101453. doi: 10.1016/j.ssmph.2023.101453. eCollection 2023 Sep.

Authors

Monica Hernandez¹, Rebeca Wong^{1

2}, Xiaoying Yu³, Neil Mehta^{4

2}

Affiliations

¹ Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA.
² Sealy Center on Aging, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA.
³ Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA.
⁴ Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA.

Abstract

Objective: To measure the association between housing insecurity and foregone medication due to cost among Medicare beneficiaries aged 65+ during the Recession.

Methods: Data came from Medicare beneficiaries aged 65+ years from the 2006-2012 waves of the Health and Retirement Study (HRS). Two-wave housing insecurity changes are evaluated as follows: (i) No insecurity, (ii) Persistent insecurity, (iii) Onset insecurity, and (iv) Onset security. We implemented a series of four weighted longitudinal General Estimating Equation (GEE) models, two minimally adjusted and two fully adjusted models, to estimate the probability of foregone medications due to cost between 2008 and 2012.

Results: Our study sample was restricted to non-proxy interviews of non-institutionalized Medicare beneficiaries aged 65+ in the 2006 wave (n = 9936) and their follow up visits (n = 8753; in 2008; n = 7464 in 2010; and n = 6594 in 2012). Results from our fully adjusted model indicated that the odds of foregone medication was 64% higher among individuals experiencing Onset insecurity versus No insecurity in 2008, and also generally larger for individuals experiencing Onset Insecurity versus Persistent Insecurity. Odds of foregone medication was also larger among females, minority versus non-Hispanic white adults, those reporting a chronic condition, those with higher medical expenditures, and those living in the South versus Northeast.

Conclusion: This study drew from nationally representative data to elucidate the disparate health and financial impacts of a crisis on Medicare beneficiaries who, despite health insurance coverage, displayed variability in foregone medication patterns. Our findings suggest that the onset of housing insecurity is most closely linked with unexpected acute economic shocks leading households with little time to adapt and forcing trade-offs in their prescription and other needs purchases. Both housing and healthcare policy implications exist from these findings including expansion of low-income housing units and rent relief post-recession as well as wider prescription drug coverage for Medicare adults.

Keywords: Foregone medication due to cost; Great recession; Health disparities; Housing insecurity; Medicare beneficiaries.

Grants and funding

P30 AG059301/AG/NIA NIH HHS/United States