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

450 Participants Needed

Trial Summary

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 data supports the effectiveness of the treatment Universal Basic Income, Guaranteed Income, Basic Income Guarantee for health care utilization?

Research on similar programs, like the Universal Health Care Coverage in Thailand and community-based health insurance in Uganda, shows that reducing financial barriers can increase health care utilization, especially among the poor and underserved populations. These findings suggest that providing a basic income could similarly improve access to health care by alleviating financial constraints. ^{1 2 3 4 5}

Is Universal Basic Income safe for health care utilization?

There is limited evidence on the safety of Universal Basic Income (UBI) specifically for health care utilization, but studies of similar interventions suggest positive effects on some health outcomes like birthweight and mental health, with no large negative impacts reported. ^{6 7 8 9 10}

How does the Universal Basic Income treatment differ from other treatments for health care utilization?

Universal Basic Income (UBI) for health care utilization is unique because it provides direct financial support to individuals, which can help them access health care services without the need for traditional insurance or tax-based systems. Unlike other treatments that focus on insurance coverage or health care delivery models, UBI directly addresses financial barriers by giving people a guaranteed income, potentially increasing their ability to pay for health care services. ^{11 12 13 14 15}

What is the purpose of this trial?

This Stage 3 efficacy study aims to address the critical need for interventions that increase access to appropriate community-based healthcare services, especially for those who have a history of incarceration and inform health policy by testing an intervention that directly reduces the racial income gap by providing a universal basic income (UBI). UBI is intended to promote and protect Black men's health through the influx of capital and subsequent increases in culturally-based protective factors such as personal agency and social connections. Participants will be split into 2 groups: the control and the intervention. Participants in the intervention group will be provided UBI of $500 per month for 6 months to increase healthcare utilization among chronically-ill, low-income Black men.

Research Team

Ashley E Williams, MHS

Principal Investigator

University of Arkansas

Eligibility Criteria

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

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

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

Timeline

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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]

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]

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 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]

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]

References

1. England pubmed.ncbi.nlm.nih.gov

The impact of the obstetrical risk insurance scheme in Mauritania on maternal healthcare utilization: a propensity score matching analysis. [2020]

2. England pubmed.ncbi.nlm.nih.gov

Seeking care in the context of social health insurance in Kenya and Ghana. [2023]

3. Ireland pubmed.ncbi.nlm.nih.gov

Impact of Universal Health Care Coverage on patient demand for health care services in Thailand. [2018]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Availability and Accessibility of Primary Care for the Remote, Rural, and Poor Population of Indonesia. [2023]

5. Switzerland 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. [2023]

6. England pubmed.ncbi.nlm.nih.gov

The public health effects of interventions similar to basic income: a scoping review. [2023]

7. Netherlands 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? [2022]

8. England pubmed.ncbi.nlm.nih.gov

The importance of wage loss in the financial burden of illness: Longitudinal evidence from India. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

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

10. Thailand pubmed.ncbi.nlm.nih.gov

Implementing the universal health coverage: which source of information is more reliable? [2018]

11. England 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? [2023]

12. New Zealand pubmed.ncbi.nlm.nih.gov

Why Do Informal Sector Workers Not Pay the Premium Regularly? Evidence from the National Health Insurance System in Indonesia. [2020]

13. England pubmed.ncbi.nlm.nih.gov

An evaluation of health systems equity in Indonesia: study protocol. [2023]

14. England pubmed.ncbi.nlm.nih.gov

Can Turkey's general health insurance system achieve universal coverage? [2019]

15. United States pubmed.ncbi.nlm.nih.gov

Mandatory membership of community-based mutual health insurance in Senegal: A national survey. [2023]