Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
JAMA. 2024 Nov 5;332(17):1455-1463. doi: 10.1001/jama.2024.13004.
Poverty is associated with greater barriers to health care and worse health outcomes, but it remains unclear whether income support can improve health.
To examine the effect of cash benefits on health care utilization and health.
DESIGN, SETTING, AND PARTICIPANTS: The City of Chelsea, Massachusetts, a low-income community near Boston, randomly assigned individuals by lottery to receive cash benefits. Participants' medical records were linked across multiple health systems. Outcomes were assessed during the intervention period from November 24, 2020, to August 31, 2021.
Cash benefits via debit card of up to $400 per month for 9 months.
The primary outcome was emergency department visits. Secondary outcomes included specific types of emergency department visits, outpatient use overall and by specialty, COVID-19 vaccination, and biomarkers such as cholesterol levels.
Among 2880 individuals who applied for the lottery, mean age was 45.1 years and 77% were female. The 1746 participants randomized to receive the cash benefits had significantly fewer emergency department visits compared with the control group (217.1 vs 317.5 emergency department visits per 1000 persons; adjusted difference, -87.0 per 1000 persons [95% CI, -160.2 to -13.8]). This included reductions in emergency department visits related to behavioral health (-21.6 visits per 1000 persons [95% CI, -40.2 to -3.1]) and substance use (-12.8 visits per 1000 persons [95% CI, -25.0 to -0.6]) as well as those that resulted in a hospitalization (-27.3 visits per 1000 persons [95% CI, -53.6 to -1.1]). The cash benefit had no statistically significant effect on total outpatient visits (424.3 visits per 1000 persons [95% CI, -118.6 to 967.2]), visits to primary care (-90.4 visits per 1000 persons [95% CI, -308.1 to 127.2]), or outpatient behavioral health (83.5 visits per 1000 persons [95% CI, -182.9 to 349.9]). Outpatient visits to other subspecialties were higher in the cash benefit group compared with the control group (303.1 visits per 1000 persons [95% CI, 32.9 to 573.2]), particularly for individuals without a car. The cash benefit had no statistically significant effect on COVID-19 vaccination, blood pressure, body weight, glycated hemoglobin, or cholesterol level.
In this randomized study, individuals who received a cash benefit had significantly fewer emergency department visits, including those related to behavioral health and substance use, fewer admissions to the hospital from the emergency department, and increased use of outpatient subspecialty care. Study results suggest that policies that seek to alleviate poverty by providing income support may have important benefits for health and access to care.
贫困与获得医疗保健的更大障碍和更糟糕的健康结果相关，但尚不清楚收入支持是否能改善健康。
研究现金福利对医疗保健利用和健康的影响。
设计、设置和参与者：马萨诸塞州切尔西市（波士顿附近的一个低收入社区）通过抽签随机分配个人接受现金福利。参与者的医疗记录通过多个医疗系统进行了关联。结果在 2020 年 11 月 24 日至 2021 年 8 月 31 日的干预期间进行评估。
通过借记卡每月提供高达 400 美元的现金福利，为期 9 个月。
主要结果是急诊就诊。次要结果包括特定类型的急诊就诊、总体和专科门诊就诊、COVID-19 疫苗接种以及胆固醇水平等生物标志物。
在 2880 名申请参加抽奖的人中，平均年龄为 45.1 岁，77%为女性。随机分配接受现金福利的 1746 名参与者与对照组相比，急诊就诊次数明显减少（每 1000 人中有 217.1 次与 317.5 次急诊就诊；调整差异，每 1000 人减少 87.0 次[95%CI，-160.2 至-13.8]）。这包括与行为健康相关的急诊就诊减少（每 1000 人减少 21.6 次就诊[95%CI，-40.2 至-3.1]）和物质使用相关的急诊就诊减少（每 1000 人减少 12.8 次就诊[95%CI，-25.0 至-0.6]）以及由此导致住院的急诊就诊减少（每 1000 人减少 27.3 次就诊[95%CI，-53.6 至-1.1]）。现金福利对总门诊就诊次数（每 1000 人 424.3 次就诊[95%CI，-118.6 至 967.2]）、初级保健就诊次数（每 1000 人减少 90.4 次就诊[95%CI，-308.1 至 127.2]）或门诊行为健康就诊次数（每 1000 人 83.5 次就诊[95%CI，-182.9 至 349.9]）没有统计学意义。与对照组相比，现金福利组的其他专科门诊就诊次数更高（每 1000 人 303.1 次就诊[95%CI，32.9 至 573.2]），特别是对于没有汽车的人。现金福利对 COVID-19 疫苗接种、血压、体重、糖化血红蛋白或胆固醇水平没有统计学意义。
在这项随机研究中，接受现金福利的人急诊就诊次数明显减少，包括与行为健康和物质使用相关的就诊次数、从急诊就诊到住院的就诊次数减少，以及增加了对门诊专科的就诊次数。研究结果表明，通过提供收入支持来减轻贫困的政策可能对健康和获得医疗保健有重要的益处。
