Universal Basic Income for Health Care Utilization

Overseen By Ashley E Williams, MHS

Age: 18+

Sex: Male

Trial Phase: Academic

Sponsor: University of Arkansas

Disqualifiers: HIV, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 6

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether a monthly universal basic income (UBI) of $500 can improve healthcare access for low-income Black men with chronic health issues. The researchers aim to determine if this financial support increases healthcare use by reducing financial stress and enhancing personal and social well-being. Participants will be divided into two groups: one will receive the monthly UBI, while the other will not. This trial targets Black or African American men recently released from incarceration in Arkansas, who have a chronic health condition and have not had a routine medical visit in the past year. As an unphased trial, it offers a unique opportunity to explore innovative ways to enhance healthcare access and well-being.

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What prior data suggests that Universal Basic Income is safe for increasing healthcare utilization?

Research has shown that Universal Basic Income (UBI) programs generally improve people's well-being. For example, a study in Kenya found that providing cash improved mental health, suggesting UBI benefits mental health. Other studies have found that UBI enhances important health-related factors, such as education and quality of life. While these studies examine UBI's overall impact, they suggest that providing a steady income usually causes no harm. Overall, evidence indicates that UBI is safe and can positively affect mental and social health, with no reports of serious side effects or negative outcomes linked to UBI programs. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Universal Basic Income (UBI) trial because it's exploring how financial stability might impact health care utilization, which is a fresh approach compared to traditional medical treatments or public health interventions. Unlike standard care options that focus directly on medical or therapeutic interventions, this trial examines whether regular financial support can indirectly improve health outcomes by reducing stress and enabling better access to resources. By providing a monthly stipend, the trial aims to understand if financial security can lead to healthier lifestyles and better compliance with medical advice, potentially transforming how we think about health care solutions for low-income populations.

What evidence suggests that Universal Basic Income could be effective for increasing healthcare utilization?

Research has shown that Universal Basic Income (UBI), which participants in the intervention arm of this trial will receive, can positively affect health. Studies have found that a guaranteed income improves mental well-being and reduces stress. One study discovered that UBI can ease access to healthcare by removing financial barriers. Another review highlighted that UBI can enhance health by reducing poverty-related stress and improving mental health. While research continues, these findings suggest that UBI could enhance health and well-being, particularly for those facing financial difficulties. ^{1 2 3 5 6}

Who Is on the Research Team?

Ashley E Williams, MHS

Principal Investigator

University of Arkansas

Are You a Good Fit for This Trial?

This trial is for Black men, aged 45+ or 25+ if HIV-positive, with at least one chronic health condition. They must have been recently released from an Arkansas correctional facility (for half the sample), speak English, consent to share personal data, and plan to stay in central Arkansas for the study duration.

Inclusion Criteria

Self-identify as Black or African American

Plan to remain in the central Arkansas area for the duration of the study period

Be willing and able to provide bi-weekly information about all activities related to seeking employment and to share financial and income-related information with the study team

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants in the intervention group receive a monthly UBI stipend of $500 for 6 months

6 months

Monthly visits for UBI distribution

Control

Participants receive a ClinCard, financial literacy materials, and instructions for follow-up assessments

6 months

Follow-up

Participants are monitored for healthcare service utilization and other secondary outcomes

6 months

Follow-up assessments at 6-month and 12-month timepoints

What Are the Treatments Tested in This Trial?

Interventions

• Universal Basic Income

Trial Overview The study tests whether a Universal Basic Income of $500 per month for six months can increase healthcare utilization among chronically-ill, low-income Black men by providing financial support and potentially improving their personal agency and social connections.

How Is the Trial Designed?

Group I: Intervention Experimental Treatment 1 Intervention

Participants in Arm 2 will receive a monthly UBI stipend of $500 for 6 months. Study staff will explain that UBI payments will continue for 6 months and that the UBI payments will be suspended if an individual is reincarcerated (e.g. the participant will not receive UBI payments to their ClinCard during months of incarceration and will not receive additional months post-release from incarceration). Participants will receive their monthly UBI payment, along with all study-related compensation for completing baseline and follow-up assessments, through a ClinCard, which is a loadable debit card with an ID number unique to the participant. The UBI will be loaded to the participant's ClinCard on the first day of each month.

Group II: Control Active Control 1 Intervention

All participants will receive the following: 1) a ClinCard and instructions for completing a weekly financial journal to record participants' spending patterns and social needs during the first 6 months of the study; 2) materials about financial literacy and community-based resources that provide support to low-income individuals; 3) description and instructions for follow-up assessments and check-ins; 4) a copy of signed medical release, consent, and HIPAA forms; 5) respondent-driven sampling referral cards; 6) 3 study referral cards, and 7) information about voter registration services provided through the Pulaski County Circuit and County Clerk's Office (https://www.pulaskiclerk.com/voter-registration/). Participants will be provided information about the importance of voting, restoration of voting rights, and the process of voting and sealing records.

Who Is Running the Clinical Trial?

University of Arkansas

Lead Sponsor

Trials

500

Recruited

153,000+

Published Research Related to This Trial

The eQuality Health Bwindi community-based health insurance (CBHI) scheme significantly improved health care utilization among children under 5, leading to a 36% reduction in mortality risk, indicating its effectiveness in enhancing access to health services.

Children with health insurance were ten times more likely to visit outpatient services and four times more likely to be admitted to hospitals, demonstrating that CBHI can substantially increase healthcare access, although its reliance on external subsidies poses challenges for broader implementation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Community-Based Health Insurance Increased Health Care Utilization and Reduced Mortality in Children Under-5, Around Bwindi Community Hospital, Uganda Between 2015 and 2017. Haven, N., Dobson, AE., Yusuf, K., et al.[2023]

The implementation of Indonesia's national health insurance scheme (JKN) has highlighted significant disparities in healthcare access, particularly in remote areas where the poor population relies heavily on primary healthcare (PHC) services, using them approximately twice as much as advanced healthcare (AHC).

Analysis revealed that the availability of healthcare resources, such as nurses and general practitioners, is crucial for effective healthcare delivery in remote regions, indicating that improving human resources is essential for achieving universal health coverage, especially for underserved populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Availability and Accessibility of Primary Care for the Remote, Rural, and Poor Population of Indonesia. Wenang, S., Schaefers, J., Afdal, A., et al.[2023]

Universal health coverage (UHC) is challenging to implement in low- and lower-middle-income countries (LLMICs) due to the infeasibility of traditional financing methods like general tax revenue and social health insurance.

The proposed Cooperative Healthcare (CH) model, which focuses on community-based risk-pooling and governance, shows promise for delivering accessible primary healthcare by leveraging local social capital, and could serve as a transitional solution until UHC becomes feasible in these regions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Financing and provision of healthcare for two billion people in low-income nations: Is the cooperative healthcare model a solution? Hsiao, WC., Yip, W.[2023]

Social Health Insurance (SHI) in Kenya and Ghana has made healthcare more affordable for clients, leading to increased frequency of care-seeking behavior, although many clients do not specifically seek SHI-accredited providers.

There is a significant need for education on SHI benefits among clients and providers, as misunderstandings about coverage can lead to inappropriate charges for services, highlighting the importance of monitoring and reforming SHI systems to ensure sustainability and accessibility, especially in rural areas.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Seeking care in the context of social health insurance in Kenya and Ghana. Suchman, L., Hashim, CV., Adu, J., et al.[2023]

The Universal Health Care Coverage (UC) Program in Thailand, implemented in 2002, successfully increased outpatient health care demand, especially among the elderly and low-income populations, with visits costing only 30 baht (less than 1 U.S. dollar).

However, while outpatient visits surged in the first year, this demand quickly declined in subsequent years, and there was a notable decrease in inpatient visits and hospital stays, indicating potential issues with the program's sustainability and effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of Universal Health Care Coverage on patient demand for health care services in Thailand. Panpiemras, J., Puttitanun, T., Samphantharak, K., et al.[2018]

Approximately 28% of informal sector workers in Indonesia do not consistently pay their health insurance premiums, with financial hardship being a significant factor that decreases compliance by 7.7 percentage points.

Factors positively influencing premium payment include stable income from agricultural work, prior healthcare costs, knowledge of health services, and access to healthcare professionals, suggesting targeted policy interventions could improve compliance rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Why Do Informal Sector Workers Not Pay the Premium Regularly? Evidence from the National Health Insurance System in Indonesia. Dartanto, T., Halimatussadiah, A., Rezki, JF., et al.[2020]

Indonesia's national health scheme, JKN, aims to provide health coverage to its entire population of 255 million by the end of 2019, but about one-third of the population still lacks coverage, highlighting significant gaps in access to healthcare.

The study will evaluate the impact of recent UHC reforms on healthcare financing, delivery, and health outcomes, focusing on ensuring that vulnerable populations are included in the coverage expansion efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An evaluation of health systems equity in Indonesia: study protocol. Wiseman, V., Thabrany, H., Asante, A., et al.[2023]

The obstetrical risk insurance (ORI) scheme in Mauritania significantly increased the likelihood of women receiving prenatal care, with a 13% increase in at least one visit and a 15% increase in facility-based births among enrolled women.

Despite improvements in prenatal and delivery care, the ORI scheme did not show any impact on postnatal care, C-section rates, or neonatal mortality, indicating areas for further improvement in maternal and child health services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of the obstetrical risk insurance scheme in Mauritania on maternal healthcare utilization: a propensity score matching analysis. Ravit, M., Ravalihasy, A., Audibert, M., et al.[2020]

The General Health Insurance System (GHIS) in Turkey, implemented in 2008, is struggling to achieve universal health coverage due to socio-economic issues like high unemployment and income inequality.

Out-of-pocket payments for health services are higher than in many European and OECD countries, limiting the depth of coverage, and the GHIS may need to shift from an insurance-based to a tax-based system to improve access and equity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can Turkey's general health insurance system achieve universal coverage? Yasar, GY., Ugurluoglu, E.[2019]

The article presents a model suggesting that Universal Basic Income (UBI) can positively influence social determinants of health, leading to improved public health outcomes and economic returns, challenging the notion that UBI is either inadequate or unaffordable.

A methodological framework is proposed for assessing the costs and health impacts of UBI, including a microsimulation approach to estimate budgetary burdens and potential fiscal strategies to fund UBI while considering its health benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Modelling the size, cost and health impacts of universal basic income: What can be done in advance of a trial? Johnson, MT., Johnson, EA., Webber, L., et al.[2022]

In India, wage loss constitutes over 80% of the economic burden of illness for the poorest households, while it only accounts for about 20% for the wealthiest, highlighting a significant socio-economic disparity in the impact of illness.

To effectively protect households from financial risks associated with illness, especially for poorer families, Universal Health Coverage (UHC) initiatives should consider including wage loss insurance or income replacement benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The importance of wage loss in the financial burden of illness: Longitudinal evidence from India. Shrinivas, A., Jalota, S., Mahajan, A., et al.[2023]

A study of a guaranteed annual income experiment in Dauphin, Manitoba, involving approximately 12,500 residents, found that hospitalization rates declined by 8.5% during the experimental period compared to matched controls.

The decline in hospitalizations was primarily attributed to reductions in accident/injury and mental health-related cases, suggesting that financial support can have significant health benefits beyond its original labor market objectives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

New questions, new data, old interventions: the health effects of a guaranteed annual income. Forget, EL.[2013]

The study validated data from national household surveys against routine reports from the Ministry of Public Health and the Social Security Office, revealing significant discrepancies in health coverage estimates.

National surveys estimated uninsured rates to be 1.5 times higher than those reported by official health authorities, highlighting the potential financial risks of using inaccurate data for implementing universal health coverage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing the universal health coverage: which source of information is more reliable? Leesmidt, V., Pannarunothai, S., Chongsuvivatwong, V.[2018]

A national survey of 914 people in Senegal revealed that 86% preferred voluntary community-based mutual health insurance (CBHI) membership over mandatory membership, indicating a significant preference for choice in health insurance.

Trust in CBHIs and the health system was crucial for acceptance of both voluntary and mandatory membership, with a lack of trust negatively impacting the willingness to accept mandatory membership.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mandatory membership of community-based mutual health insurance in Senegal: A national survey. Ridde, V., Gaye, I., Ventelou, B., et al.[2023]

A systematic review of 27 studies on basic income-like interventions found mixed health effects, with notable positive impacts on outcomes like birthweight and mental health, but no significant effects on other health measures.

Employment outcomes varied, showing mostly small effects for men and larger positive effects for women with young children, suggesting that basic income may not lead to significant job loss and could improve certain socioeconomic conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The public health effects of interventions similar to basic income: a scoping review. Gibson, M., Hearty, W., Craig, P.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8036241/

Modelling the size, cost and health impacts of universal basic ... This article presents a model of UBI's health impact, using a framework to assess costs and returns, and a methodological framework for research.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11180702/

Effects of guaranteed basic income interventions on poverty ... Effects of guaranteed basic income interventions on poverty‐related outcomes in high‐income countries: A systematic review and meta‐analysis

3. urbanlabs.uchicago.edu urbanlabs.uchicago.edu/attachments/5ff88f36218ed7d9bee03d8b2e3f5e87998b51c9/store/71b4d2b6c98f6d7d0e4b8e5ac62db72a0139a748a1dc59ee192309d9e7cf/092024+IEL+GI+Literature+Review.pdf

A summary of existing research on guaranteed income. Findings from the Kenya. Universal Basic Income Program indicate that the cash transfers significantly improved participants' overall psychological well-being, ...

4. givedirectly.org givedirectly.org/2023-ubi-results/

Early findings from the world's largest UBI study This study finds that, while both have a positive impact, giving someone ~$500 as a lump sum rather than a short-term UBI is more effective across most ...

5. basicincome.stanford.edu basicincome.stanford.edu/uploads/Umbrella%20Review%20BI_final.pdf

WHAT WE KNOW ABOUT UNIVERSAL BASIC INCOME UBI is a recurrent cash transfer to all community members, regardless of income, with no strings attached, often to cover essential living costs.

6. drexel.edu drexel.edu/hunger-free-center/research/briefs-and-reports/universal-basic-income/

Universal Basic Income - Home UBI pilots show improved outcomes in health and quality of life in several social determinants of health, including better educational outcomes, fewer instances ...