Affiliates' Research in Medical Journals, Fall 2024

Many NBER-affiliated researchers publish some of their health-related findings in journals that preclude pre-publication distribution, and thus do not post them as NBER Working Papers. This is a partial listing of recent papers in this category by NBER affiliates.

Effect of Cash Benefits on Health Care Utilization and Health: A Randomized Study
Agarwal SD, Cook BL, Liebman JB. JAMA 332(17), July 2024, pp. 1455–1463.

To examine the effect of cash benefits on health care utilization and health, the City of Chelsea, a majority Latino and immigrant community near Boston, randomly assigned low-income individuals by lottery to receive cash benefits: a debit card of up to $400 per month for 9 months. To address the limitations of past studies examining the effects of income support on health, in this study participants’ medical records were linked across multiple health systems. Outcomes were assessed during the intervention period from November 24, 2020, to August 31, 2021. Among 2,880 lottery applicants, the 1,746 participants randomized to receive the cash benefits had significantly fewer emergency department visits compared with the control group (217.1 versus 317.5 visits per 1,000 persons), including visits related to behavioral health and substance use, as well as those that resulted in a hospitalization. The cash benefit had no statistically significant effect on total outpatient visits (424.3 visits per 1,000 persons), visits to primary care (−90.4 visits per 1,000 persons), or outpatient behavioral health (83.5 visits per 1,000 persons). Outpatient visits to other subspecialties were higher in the cash benefit group (303.1 visits per 1,000 persons), particularly for individuals without a car. The results run counter to a common belief that cash benefits enable misuse of substances and alcohol to the detriment of health. They also suggest that rather than a substitution of primary care for emergency care, the lower emergency room use resulted from a direct improvement in health from the cash benefit. There was no statistically significant effect of the cash benefit on COVID-19 vaccination, blood pressure, body weight, glycated hemoglobin, or cholesterol level, though power was limited by the small number of patients who had hypertension, hyperlipidemia, or diabetes, and the 9-month follow-up period. 

Major Traffic Safety Reform and Road Traffic Injuries Among Low-Income New York Residents, 2009–2021
Dragan KL, Glied SA. American Journal of Public Health 114(6), June 2024, pp. 633–641.

This study uses New York State individual-level Medicaid data to evaluate the impact of a comprehensive traffic safety policy on low-income residents. Vision Zero, modeled on a Swedish program and implemented in several US cities, was implemented in New York City (NYC) in 2014. It comprised over 100 interventions through six agencies, including speed limit reduction from 30 to 25 mph, physical modifications such as protected bike lanes, vehicle mandates such as trailer sideguards, educational campaigns, and traffic law enforcement. Difference-in-differences analyses measured traffic injuries and expenditures from 2009 to 2021, comparing NYC to surrounding counties without traffic reforms (n = 65,585,568 person-years). Medicaid data enabled a focus on the most vulnerable populations, which is important given that low-income and Black Americans are more likely to live and work in places with unsafe roadways and face injuries. After Vision Zero, injury rates among NYC Medicaid enrollees diverged from those in surrounding counties, with a significant net impact of 77.5 fewer injuries per 100,000 person-years annually. There were marked reductions in severe injuries (brain injury, hospitalizations), indicating that the traffic policy reduced severe crashes and not just ”low-hanging fruit” (e.g., fender-benders). The estimated savings over the first five years of Vision Zero were $4.34 per enrollee in annual Medicaid expenditures, amounting to total savings of $90.8 million. The effects were largest among Blacks. Despite growth in crash incidence in non-NYC areas, the injury trend in NYC stayed persistently lower than the trend in nearby counties until the onset of the pandemic, when reckless driving increased and enforcement declined.

Heterogeneity and Predictors of the Effects of AI Assistance on Radiologists
Yu F, Moehring A, Banerjee O, Salz T, Agarwal N, Rajpurkar P. Nature Medicine 30, March 2024, pp. 837–849.

The integration of artificial intelligence (AI) in medical image interpretation requires effective collaboration between clinicians and AI algorithms. This large-scale study examines the impact of AI on clinicians, measuring the heterogeneous effects of AI assistance on 140 radiologists across 15 chest X-ray diagnostic tasks and identifying predictors of these effects. Conventional experience-based factors, such as years of experience, subspecialty, and familiarity with AI tools, fail to reliably predict the impact of AI assistance. Additionally, lower-performing radiologists do not consistently benefit more from AI assistance, challenging prevailing assumptions and previous research. The observed variability could be attributed to the larger and more diverse sample of radiologists and to the inclusion of a wide range of diagnostic tasks. Without reliable predictors, decisions about using AI could be informed by directly measuring individual radiologists’ responses to AI assistance using an experimental dataset that is representative of the target patient population. The occurrence of AI errors strongly influences treatment outcomes, with inaccurate AI predictions adversely affecting radiologist performance on the aggregate of all pathologies and on half of the individual pathologies investigated. These findings highlight the importance of personalized approaches to clinician-AI collaboration and accurate AI models. 

Implementation of New Mexico's 'No Behavioral Health Cost Sharing' Law: A Qualitative Study
Harris SJ, Golberstein E, Maclean JC, Stein BD, Ettner SL, Saloner B. Health Affairs 43(10), October 2024, pp. 1448–1454.

Cost-Associated Unmet Dental, Vision, and Hearing Needs Among Low-Income Medicare Advantage Beneficiaries
Gupta A, Johnston KJ, Silver D, Meyers DJ, Glied SA, Pagán JA. Health Affairs 43(10), October 2024, pp. 1392–1399.

Mortality Caused by Tropical Cyclones in the United States
Young R, Hsiang S. Nature 635, October 2024, pp. 121–128.

Addressing Social Needs in Oncology Practices: A Case Study of a Patient-Centered Approach Using Health Information Technology
Parsons H, Haynes D, Blaes A, Church T, Halberg J, Johnson S, Karaca-Mandic P. Journal of Clinical and Translational Science 8(1), September 2024.

Medicaid/CHIP Coverage for Immigrants During Pregnancy, Childhood, and Adulthood: A Discussion of Relevant Policies and Evidence
Wherry L, Fabi R, Steenland M. Journal of Health Politics, Policy and Law, September 2024.

Physician-Patient Racial Concordance and Newborn Mortality
Borjas GJ, VerBruggen R. PNAS 121(39), September 2024.

Heterogeneous Effects of Medicaid Coverage on Cardiovascular Risk Factors: Secondary Analysis of Randomized Controlled Trial
Inoue K, Athey S, Baicker K, Tsugawa Y. BMJ 386, September 2024.

Return on Investments in Social Determinants of Health Interventions: What Is the Evidence?
Nikpay S, Zhang Z, Karaca-Mandic P. Health Affairs Scholar 2(9), September 2024.

Child Mental Health, Homelessness, and the Shelter System: Evidence from Medicaid in New York City
Cassidy M, Currie J, Glied S, Howland R. American Journal of Epidemiology, September 2024.

Small for Gestational Age and Age at Menarche in a Contemporary Population-Based US Sample
Sabu S, Corman H, Noonan K, Reichman NE, Kuhn KB, Radovick S. PLOS ONE 19(9), September 2024.

Association of Daily Doses of Buprenorphine with Urgent Health Care Utilization
Axeen S, Pacula RL, Merlin JS, Gordon AJ, Stein BD. JAMA Network Open 7(9), September 2024.

Surgical Approach and Long-Term Recurrence After Ventral Hernia Repair
Fry BT, Howard RA, Thumma JR, Norton EC, Dimick JB, Sheetz KH. JAMA Surgery 159(9), September 2024, pp. 1019–1028.

Prior Authorization Requirements and Medicaid Enrollees’ Use of Tobacco Cessation Medications, Colorado, 2023
Dillender M, Mermelstein R. American Journal of Public Health, August 2024.

Looks and Longevity: Do Prettier People Live Longer?
Sheehan CM, Hamermesh DS. Social Science & Medicine 354, August 2024.

Colorado Insulin Copay Cap: Lower Out-of-Pocket Payments, Increased Prescription Volume and Days' Supply
Ukert BD, Giannouchos TV, Buchmueller TC. Health Affairs 43(8), August 2024, pp. 1147–1155.

Oregon's Hospital Payment Cap and Enrollee Out-of-Pocket Spending and Service Use
Murray RC, Norton EC, Ryan AM. JAMA Health Forum 5(8), August 2024.

Health Outcome Changes in Individuals with Type 1 Diabetes After a State-Level Insulin Copayment Cap
Giannouchos TV, Ukert B, Buchmueller T. JAMA Network Open 7(8), August 2024.

Utilization of Low- and High-Value Health Care by Individuals With and Without Cognitive Impairment
Barthold D, Jiang S, Basu A, Phelan EA, Thielke S, Borson S, Fendrick AM. American Journal of Managed Care 30(7), July 2024, pp. 316–323.

Provision of Stroke Care Services by Community Disadvantage Status in the US, 2009–2022
Hsia RY, Sarkar N, Shen Y. JAMA Network Open 7(7), July 2024.

Machine Learning for Detection of Heterogeneous Effects of Medicaid Coverage on Depression
Goto R, Inoue K, Osawa I, Baicker K, Fleming SL, Tsugawa Y. American Journal of Epidemiology 193(7), July 2024, pp. 951–958.

Structural Inequities in the Adoption of Percutaneous Coronary Intervention Service by US Hospitals, 2000–20
Hsia RY, Shen Y. Health Affairs 43(7), July 2024,  pp. 1011–1020.

Patient Out-of-Pocket Costs for Type 2 Diabetes Medications When Aging into Medicare
Barthold D, Li J, Basu A. JAMA Network Open 7(7), July 2024.

Isolating the Drivers of Racial Inequities in Prostate Cancer Treatment
Hammarlund N, Holt SK, Basu A, Etzioni R, Morehead D, Lee JR, Wolff EM, Gore JL, Nyame YA. Cancer Epidemiology, Biomarkers & Prevention 33(3), March 2024, pp. 435–441.