ImportancePoverty is associated with greater barriers to health care and worse health outcomes, but it remains unclear whether income support can improve health.ObjectiveTo examine the effect of cash benefits on health care utilization and health.Design, Setting, and ParticipantsThe 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.InterventionCash benefits via debit card of up to $400 per month for 9 months.Main Outcomes and MeasuresThe 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.ResultsAmong 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 RelevanceIn 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.

中文翻译：

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现金福利对医疗保健利用和健康的影响


重要性贫困与更大的医疗保健障碍和更差的健康结果有关，但目前尚不清楚收入支持是否可以改善健康。目的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是波士顿附近的一个低收入社区，通过抽签随机分配个人以获得现金福利。参与者的医疗记录在多个卫生系统之间相互关联。在2020年11月24日至2021年8月31日的干预期间对结果进行了评估。干预通过借记卡提供的现金福利最多为每月400美元，持续9个月。主要结果和措施主要结果是急诊科就诊。次要结果包括特定类型的急诊科就诊、整体和专业门诊就诊、COVID-19 疫苗接种以及胆固醇水平等生物标志物。 结果在申请抽签的 2880 名个人中，平均年龄为 45.1 岁，其中 77% 为女性。与对照组相比，随机接受现金福利的 1746 名参与者的急诊就诊次数显着减少（每 1000 人 217.1 次急诊就诊 vs 317.5 次急诊就诊；调整后差异，每 1000 人 -87.0 [95% CI，-160.2 至 -13.8] ）。这包括与行为健康相关的急诊就诊次数的减少（每 1000 人 -21.6 次就诊 [95% CI，-40.2 至 -3.1]）和药物使用（每 1000 人 -12.8 次就诊 [95% CI，-25.0 至 -0.6]） ]）以及导致住院的那些（每 1000 人 -27.3 次就诊 [95% CI，-53.6 至 -1.1]）。现金福利对门诊总就诊次数没有统计学上的显着影响（每 1000 人 424.3 次就诊 [95% CI，-118.6 至 967]。2]）、就诊初级保健（每 1000 人 -90.4 次就诊 [95% CI，-308.1 至 127.2]）或门诊行为健康（每 1000 人 83.5 次就诊 [95% CI，-182.9 至 349.9]）。与对照组相比，现金福利组其他专科的门诊就诊次数更高（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个人。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上的显着影响。结论和相关性在这项随机研究中，接受现金福利的个人去急诊室的次数明显减少，包括那些相关的急诊科就诊次数。行为健康和药物使用、急诊科入院人数减少以及门诊亚专科护理的使用增加。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服务有重要好处。