title: Upstream solutions: does the supplemental security income program reduce disability in the elderly?
abstract: BACKGROUND
  The robust relationship between socioeconomic factors and health suggests that social and economic policies might substantially affect health, while other evidence suggests that medical care, the main focus of current health policy, may not be the primary determinant of population health. Income support policies are one promising avenue to improve population health. This study examines whether the federal cash transfer program to poor elderly, the Supplemental Security Income (SSI) program, affects old-age disability.
  
  
  METHODS
  This study uses the 1990 and 2000 censuses, employing state and year fixed-effect models, to test whether within-state changes in maximum SSI benefits over time lead to changes in disability among people aged sixty-five and older.
  
  
  RESULTS
  Higher benefits are linked to lower disability rates. Among all single elderly individuals, 30 percent have mobility limitations, and an increase of $100 per month in the maximum SSI benefit caused the rate of mobility limitations to fall by 0.46 percentage points. The findings were robust to sensitivity analyses. First, analyses limited to those most likely to receive SSI produced larger effects, but analyses limited to those least likely to receive SSI produced no measurable effect. Second, varying the disability measure did not meaningfully alter the findings. Third, excluding the institutionalized, immigrants, individuals living in states with exceptionally large benefit changes, and individuals living in states with no SSI supplements did not change the substantive conclusions. Fourth, Medicaid did not confound the effects. Finally, these results were robust for married individuals.
  
  
  CONCLUSIONS
  Income support policy may be a significant new lever for improving population health, especially that of lower-income persons. Even though the findings are robust, further analyses are needed to confirm their reliability. Future research should examine a variety of different income support policies, as well as whether a broader range of social and economic policies affect health.
authors.affiliation: University of Wisconsin, Madison, WI 53706, USA. pherd@lafollette.wisc.edu
authors.forename: Pamela
authors.initials: P
authors.lastname: Herd
authors.forename: Robert F
authors.initials: RF
authors.lastname: Schoeni
authors.forename: James S
authors.initials: JS
authors.lastname: House
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D019352:Censuses; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008484:Medicaid; D017059:Models, Econometric; D011050:Policy Making; D012943:Social Security / Q000191:economics*; D014481:United States