Effect of Cash Benefits on Health Care Utilization

Using data from the Chelsea Eats program, we propose to study a randomized controlled trial in which the City of Chelsea, Massachusetts held a lottery to allocate cash benefits to its residents for ten months during the first two years of the COVID-19 pandemic. We will analyze the impact of the cash benefit on health care utilization and health.

Study Overview

• Status: Completed
• Conditions: Health Care Utilization
• Intervention / Treatment: Other: Cash Benefit; Other: No Cash Benefit

• Study Type: Interventional
• Enrollment (Actual): 3615
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02115
      • Harvard Medical School

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Resident of Chelsea, Massachusetts
• Household income at or below 30% of the U.S. Department of Housing and Urban Development's Area Median Income

Exclusion Criteria:

• See inclusion criteria

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Treatment Group; Participants in the treatment group received up to $400 per month.	Other: Cash Benefit; Spending from the cards was not restricted to food but could be spent on anything and anywhere Visa was accepted. The debit cards were credited with the first payment on November 18th, 2020 and the second payment on December 18th, 2020. The program continued with monthly credits through August 2021.; Other Names: Basic Income; Debit Card
Active Comparator: Control Group; Participants in the control group did not receive monthly cash benefits.	Other: No Cash Benefit; No monthly cash benefit.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Emergency department use	Count of visits to the emergency department (ED) using the electronic health record	10 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Behavioral health-related ED visit	Visits to the ED with a behavioral health-related diagnosis code	10 months
Substance use disorder-related ED visit	Visits to the ED with a substance use disorder-related diagnosis code	10 months
Potentially avoidable ED visit	Visits to the ED that are potentially avoidable, categorized as avoidable according to the previously validated New York University algorithm	10 months
ED visit resulting in admission to the hospital	Visits to the ED that result in a hospitalization	10 months
Outpatient service use	Office visits and visits for other types of outpatient care such as imaging and procedures	10 months
COVID vaccination	Binary variable for having received at least one dose of any COVID vaccine by the end of the trial period	10 months
Hemoglobin A1c	Continuous measure of diabetes, using the latest available reading or result during trial period	10 months
Blood pressure	Continuous measure of blood pressure, using the latest available reading or result during trial period	10 months
Weight	Continuous measure of weight, using the latest available reading or result during trial period	10 months
Cholesterol	Continuous measure of cholesterol, using the latest available reading or result during trial period	10 months

Collaborators and Investigators

• Sponsor: Harvard Medical School (HMS and HSDM)
• Collaborators: Brigham and Women's Hospital; Cambridge Health Alliance
• Investigators: Principal Investigator: Sumit Agarwal, MD, MPH, Brigham and Women's Hospital and Harvard Medical School

Study record dates

Study Major Dates

• Study Start (Actual): July 27, 2020
• Primary Completion (Actual): December 31, 2021
• Study Completion (Actual): February 1, 2024

Study Registration Dates

• First Submitted: November 14, 2022
• First Submitted That Met QC Criteria: November 14, 2022
• First Posted (Actual): November 21, 2022

Study Record Updates

• Last Update Posted (Actual): July 12, 2024
• Last Update Submitted That Met QC Criteria: July 11, 2024
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: 2022P000093

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No