Cash rewards have modest health results for low-income families

Thousands of New York City families were offered cash transfers from 2007-10 if they participated in a number of healthcare, educational and employment activities.
By Allen Cone  |  Updated March 8, 2018 at 5:08 PM
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March 8 (UPI) -- Low-income families in New York were given thousands of dollars as a reward if they participate in a number of activities, including preventive healthcare, school attendance and employment, but researchers were surprised they did not see larger health benefits.

From a medical standpoint, the increased benefits were modest for Opportunity NYC-Family Rewards, the first conditional cash transfer randomized controlled trial for low-income families in the United States, researchers involved with the experiment report.

From 2007 to 2010, Family Rewards offered 2,377 New York City families cash transfers of $8,674. Another 2,372 families services at the control group didn't receive benefits.

Health aspects of the program were recently examined by researchers at King's College London, Columbia University's Mailman School of Public Health and MDRC, part of LIFEPATH, a project funded by the European Commission and results of the analysis were published this week in the journal Health Affairs.

While it seems that the families, or anybody, would complete tasks to receive free money, the researchers say that it may not be that simple for some people.

"Lower-income populations have a lot going on in their lives," study auther Peter Muennig, a professor of Health Policy and Management at Mailman, told UPI. "Some people work two or even three jobs and have kids to boot, so it's not easy getting medical care, even if there are funds for it."

Families that received funds, compared with those in the control group, had a 4 percent increase in accessing personal health care providers and 15 percent greater dental check-ups.

There was a 13 percent increase in the number of adults who had least two dental check-ups in the previous year, and a nearly 15 percent increase dental check-ups in children 42 months after the program started.

Family Rewards also had positive effects on health insurance coverage and treatment for any medical condition. And because they had the funds, participants were also less likely to forgo medical care, according to the researchers.

Overall, these benefits translated into modest improvements in health status when measured by self-rated health and level of hope, and researchers say the increases were not as significant as they'd expected.

"These kinds of programs have worked very well with low-income populations in other countries," Muennig said. "What is surprising to me is that there were not bigger effects. People should go out and get benefits when they are available. And when they are tied to cash payments, even more so. In this sense, it is somewhat surprising that the impact was modest."

The study also reflected the need for funds for mental health, the researchers say.

"This study really hits home a growing body of evidence on how important money is for mental health," Muennig said. "Participants who received the cash reward felt healthier and had better mental health. The few other social science experiments that are out there support this."

Although the program was administered in six of New York City's most deprived communities in the Bronx, Brooklyn and Manhattan, the city is not lacking in healthcare.

"At the time that the study was started, New York was one of the healthiest places to live, even if you are poor," Muennig said. "Life expectancy among the poor is a lot higher than in other cities. I think if you target higher-risk populations, particularly in low-income countries, it is easier to see disease. If it works here, it works anywhere."

Lead author Dr. Emilie Courtin, a research fellow at the Department of Global Health and Social Medicine, King's College London, saw benefits in New York.

"In the context of New York City's existing fabric of social policies, conditional cash transfers have also led to positive, albeit modest, improvements in the health of poor families," she said.

Cash programs were introduced in Mexico and Brazil in 1997. Across Latin America, they have led to significant increases in the use of health services, including the number of visits to health facilities as well as prenatal care and pediatric examinations. Some advantages include better developmental, nutritional and cognitive measures among children.

The programs have the support of the World Bank and other international financial institutions.

"Conditional cash transfer programs have been increasingly popular in low- and middle-income countries in Latin America, Africa and Asia," Professor Paolo Vineis, chair of Environmental Epidemiology within the School of Public Health at Imperial College London and coordinator of the LIFEPATH project, said in a Columbia press release. "However, programs with different types of behavioral conditionality are also gaining ground in various developed countries, and our study can help to encourage their establishment in Europe."

The researchers found a wealth of information from this study -- a randomized-controlled trial that is considered the gold standard for finding out if a program like this works.

"There are very few programs that look at experimental health impacts from social policy experiments, so it's very important to look at them where you can find them," Muennig said.

The researchers say they are also planning followup research.

"There is a 'part II' of the 2010 study," Muennig said. "We are working with the social research organization, MDRC, to look at the health benefits of other social programs as well. Too often, health benefits are overlooked."

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