Essays on preventive care and children's health Public Deposited

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  • March 20, 2019
Creator
  • Jones, David J.
    • Affiliation: College of Arts and Sciences, Department of Economics
Abstract
  • In light of concerns over rising health care expenditures in the U.S., the need to develop low-cost methods of reducing health risks is more pressing than ever before. In many cases, effective preventive care can reduce the need for more expensive curative care later in life. If preventive care can be a sufficiently useful substitute for curative care and a sufficiently cost-effective one, a shift towards this type of behavior could greatly benefit society. While preventive care may be beneficial at all ages, the greatest potential individual and societal benefits may be found in young children during crucial stages of development. It is also reasonable to assume that subsections of the population, for instance those of a lower socioeconomic status and the uninsured, will benefit more from preventive care. Unfortunately, we lack a thorough understanding of the connection between preventive care and reduced health risks. It has proven difficult to establish causal links between preventive behaviors and illnesses later in life. There is also a dearth of evidence concerning factors that impact consumption of preventive care, such as health insurance status. My thesis is composed of two essays that contribute to the understanding of the potential health implications and benefits of preventive care and factors that affect the demand for preventive care in the U.S. In the first essay, I investigate the impact of treatment of lead-based paint hazards in housing units (the preventive action) on childhood lead poisoning (the health outcome) at the census tract level in Chicago, in order to gain a better understanding of the effects of an investment in primary prevention on health. I use the findings from the analysis to simulate and then weigh the costs of lead interventions against the potential benefits of reducing blood lead levels in children. Childhood lead poisoning presents a particularly useful example of the efficacy of preventive care in reducing the incidence of a disease. There is a clear, well-defined pathway of exposure (deteriorating lead paint in older homes) and no method of secondary care that effectively mitigates the negative health effects. I find that a one-tenth percentage point increase in the proportion of older housing units that have been remediated is associated with a five to six-tenths percentage point reduction in the incidence of childhood lead poisoning. Citywide, this is roughly 1.75 cases of lead poisoning averted for every housing unit remediated. Furthermore, I find evidence that the effect of remediations in preventing the disease has improved over time. The lower bound estimates of the benefits associated with the reduction in lead poisoning - increased expected lifetime earnings and reduced medical expenditures - is two to ten times the estimated costs of the remediations. In the second essay, I estimate the impact of expansions of two public health insurance programs, Medicaid and the State Children's Health Insurance Program (SCHIP), on the utilization of preventive care among children. Health insurance provides various incentives for individuals to alter their medical care utilization. A host of studies have established a positive association between increased eligibility for public health insurance and medi-cal care utilization of children, but few focus on medical preventive care. This essay is a comprehensive examination of the causal relationship between the increased eligibility for Medicaid and SCHIP over a seven year period from 1997 to 2003 and consumption of well-child care and immunizations. I explore the differential impacts of eligibility across various subpopulations such as parental education, country of origin, and race to investigate how different groups react to the incentives provided by public health insurance. I use variation in the income cutoffs for Medicaid and SCHIP across states, time, and age groups to identify the effect of eligibility for public health insurance. I find that eligibility for public health insurance is associated with a 14 percentage point increase in the likelihood of consuming preventive physician visits and a two percentage point increase in the probability of having a usual source of care. Regarding immunizations, the evidence suggests that, in general, the incentives provided by eligibility are not enough to induce families to increase utilization. Hispanic children and those born outside of the U.S. do not increase utilization when made eligible to the extent of their counterparts. Black children and those neither black or white take greater advantage of eligibility in establishing a usual source of preventive care. Conversely, the likelihood of having a physician's office as a usual source of preventive care increased more among white children.
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  • In Copyright
Advisor
  • Gilleskie, Donna B.
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