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Effect of Cash Benefits on Health Care Utilization and Health: A Randomized Study
Sumit D Agarwal1,2, Benjamin Lê Cook2,3, Jeffrey B Liebman4,5
1Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA
|July 22, 2024
Summary
Providing cash benefits reduced emergency department visits, including those for behavioral health and substance use, in a low-income community. Income support may improve health and healthcare access for vulnerable populations.
Area of Science:
- Public Health
- Health Economics
- Social Determinants of Health
Background:
- Poverty presents significant barriers to healthcare access and leads to poorer health outcomes.
- The impact of direct income support on health utilization and outcomes remains under-examined.
Purpose of the Study:
- To investigate the effect of unconditional cash benefits on healthcare utilization and health status.
- To assess whether income support can mitigate health disparities associated with poverty.
Main Methods:
- A randomized controlled trial was conducted in Chelsea, Massachusetts, involving individuals receiving monthly cash benefits.
- Participants' healthcare utilization was tracked via linked medical records across multiple health systems.
- Outcomes included emergency department visits, outpatient use, COVID-19 vaccination, and biomarkers.
Main Results:
- Cash benefit recipients showed a significant reduction in overall emergency department visits (-87.0 per 1000 persons).
- Reductions were observed in emergency department visits for behavioral health and substance use, and hospital admissions.
- Increased outpatient subspecialty care utilization was noted, particularly for those without personal transportation.
Conclusions:
- Direct income support, such as cash benefits, can lead to decreased emergency department use and improved access to specialized outpatient care.
- Policies aimed at poverty alleviation through income support may yield substantial improvements in population health and healthcare access.
- Further research is warranted to explore long-term health impacts and cost-effectiveness of income support programs.
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