Housing as a determinant for development and health expenditure in Bhutan

This study positions housing as an upstream determinant of socioeconomic development and health expenditure in Bhutan, extending its conceptualisation beyond that of a physical asset. Using nationally representative data from the Bhutan Living Standards Surveys (BLSS) spanning 14 years, from 2003 to 2017, the analysis proceeds in two parts. First, we examine housing characteristics as indicators of socioeconomic development, proxied by mean monthly household expenditure (MMHE). Higher-MMHE households were more likely to occupy dwellings with improved construction materials, greater living space, cleaner energy sources, and better sanitation, demonstrating a clear socioeconomic gradient in housing quality. Second, using the 2017 BLSS, propensity score matching was applied to estimate differences in total health expenditure associated with specific housing conditions, as a proxy for household health burden and healthcare utilisation. Households with three or fewer rooms, cement, concrete, or tile flooring, and reliance on polluting cooking fuels incurred significantly higher health expenditure. These results reinforce that housing quality is closely associated with socioeconomic development and that specific housing conditions contribute to household health burden, even within Bhutan’s context of free public healthcare. Housing should therefore be recognised as an important upstream target for integrated development and preventive health policy.