Although it is well-documented that poverty can be a barrier to adequate health care, it is unclear whether income support can improve outcomes and help control costs.

"Income support administered as a cash benefit could, for example, reduce financial strain and improve mental health," according to a study published in the Journal of the American Medical Association. "It could also help pay the costs associated with accessing health care. On the other hand, a common belief about cash benefits, supported by several cross-sectional and quasi-experimental studies, is that they enable misuse of substances and alcohol to the detriment of health."

The city of Chelsea, Mass., a low-income community near Boston, randomly assigned individuals to receive debit cards with cash benefits of up to $400 a month for nine months. Researchers examined the impact of these benefits on emergency department and outpatient care; COVID-19 vaccination; and other markers of health measured in electronic heath record data from hospitals and health systems. Among the findings:

• Emergency department use. During the nine-month intervention period, there were 217.1 emergency department visits per 1,000 persons in the cash benefit group and 317.5 emergency department visits per 1,000 persons in the control group. The adjusted difference was 87 fewer visits per 1,000 persons. The largest relative decreases were among behavioral health–related emergency department visits, with a decrease of 62% relative to the control mean, and substance use–related visits, representing a relative decrease of 87%. There also were reductions in emergency department visits that resulted in hospitalization
• Outpatient use. There were 4,313.6 outpatient visits per 1,000 persons in the control group during the intervention period. Although the number of outpatient visits was higher in the cash benefit group by 424.3 visits per 1,000 persons, this adjusted difference was not statistically significant, researchers said.
• COVID-19 vaccinations. The vaccination rate in the control group was 84.2%, and the cash benefit had no statistically significant effect on COVID-19 vaccination rates.

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