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Atlanta Marriott Marquis, A602
Hosted By:
American Economic Association
Lifecycle Impacts of Early Childhood Healthcare
Paper Session
Friday, Jan. 4, 2019 10:15 AM - 12:15 PM
- Chair: Hilary Hoynes, University of California-Berkeley
The Short- and Long-Term Effects of Large-Scale Prenatal Care Interventions
Abstract
Little evidence exists on whether policy interventions explicitly designed to improve fetal health in the U.S. can generate long-lasting benefits. In this paper, we evaluate whether there are improvements in the short- and long-term outcomes of individuals who benefited from publicly-funded prenatal intervention while in utero. We examine the effects of a set of landmark policies in the state of California to expand access to medical and support services to low-income pregnant women in the late 1980s and early 1990s. During this period, California expanded eligibility for prenatal Medicaid coverage to undocumented immigrants and to women with family incomes below 200% FPL. The state also launched the Comprehensive Perinatal Services Program (CPSP), an “enhanced” prenatal care program providing additional services to low-income women receiving routine obstetrical care under Medicaid, including comprehensive risk assessments and targeted support services. To identify the effects of these early health interventions, we apply quasi-experimental methods that take advantage of variation in exposure to the policies across different counties and population groups. We use state hospital discharge data to examine changes in insurance coverage for delivery and pregnancy outcomes. We also use a novel dataset that links birth certificate data for individuals born in California to federal survey and administrative data to examine short- and long-term outcomes for the children who benefited from these interventions while in utero. These data contain information on health at birth and later life outcomes, including mortality, disability, educational attainment, labor force participation, income, and participation in public programs.Long-run Health and Mortality Effects of Exposure to Universal Health Care at Birth
Abstract
In this paper we investigate to what extent access to universal healthcare influences later life health outcomes. We examine a fundamental re-organisation of the healthcare environment to universal healthcare in the United Kingdom, which occurred through the introduction of the National Health Service (NHS) in July 1948. Immediate large decreases in infant mortality ensued, which were focused on the neo-natal period and larger for individuals who prior to the NHS had a lower access to medical services. Using administrative data on mortality, we compare mortality outcomes above age 50 of individuals born in the immediate cohorts around the introduction of the National Health Service (NHS) in a regression discontinuity design. We additionally exploit geographical variation in the change in medical services upon the NHS introduction for identification. Our findings indicate that age-specific survival rates are systematically higher among lower class individuals whose post-natal care expanded through the NHS. We supplement these findings with analysis of hospital records, which reveal a decrease in hospitalisations for cardiovascular disease for lower class individuals. These long run impacts of birth exposure to universal healthcare coverage through the NHS are economically significant, representing a 16% reduction in mortality by age 64.Discussant(s)
Benjamin Elsner
,
University College Dublin
Joachim Winter
,
Ludwig-Maximilian University-Munich
Hilary Hoynes
,
University of California-Berkeley
Jonathan Gruber
,
Massachusetts Institute of Technology
JEL Classifications
- I1 - Health