The Effect of a U.S. Poverty Reduction Intervention on Maternal Assessments of Young Children's Health, Nutrition, and Sleep: A Randomized Control Trial

Effect of Cash Benefits on Health Care Utilization and Health: A Randomized Study

Importance

Poverty is associated with greater barriers to health care and worse health outcomes, but it remains unclear whether income support can improve health.

Objective

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.

Intervention

Cash benefits via debit card of up to $400 per month for 9 months.

Main Outcomes and Measures

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.

Results

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.

Conclusions and Relevance

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.

Baby bump? Birth month, family income, and early childhood development

Federal and state laws in the U.S. provide families with babies born just before the end of the year with thousands of dollars in tax savings. Because this income windfall is realized during the first few months of a newborn's life, we assess whether babies born in December experience developmental advantages in early childhood compared to those born right after the New Year. Using data from the Child Development Supplement of the Panel Study of Income Dynamics and the Children of the National Longitudinal Survey of Youth, we implement a regression discontinuity design that exploits variation in birth timing. We first illustrate that the tax savings received by families with end of year babies are substantial. We then show that while children born in December have a weight disadvantage at birth compared to those born in January, they have an average weight-gain advantage of between 0.7 and 1.5 pounds (0.08-0.17 standard deviations) during subsequent follow-up interviews. We also find that end-of-year babies reach early developmental milestones faster, but exhibit no advantage in memory, word recognition, or applied problem solving. This end-of-year birth developmental advantage is consistent with the identified tax savings from end-of-year births.

Prescription for Cash? Cash Support to Low-Income Families in Maternal and Pediatric Health Care Settings

Policy Points Pregnancy and childhood are periods of heightened economic vulnerability, but current policies for addressing health-related social needs, including screening and referral programs, may be insufficient because of persistent gaps, incomplete follow-up, administrative burden, and limited take-up. To bridge gaps in the social safety net, direct provision of cash transfers to low-income families experiencing health challenges during pregnancy, infancy, and early childhood could provide families with the flexibility and support to enable caregiving, increase access to health care, and improve health outcomes.