Janet Currie Publications

We review recent evidence on longer-term effects of Medicaid coverage during the prenatal period and in childhood and ask whether the benefits of these investments outweigh their costs. Included studies were published since 2015, follow cohorts for at least 10 years, and estimate the impacts of prenatal or childhood Medicaid eligibility on adult health, mortality, education, income, crime, and/or intergenerational outcomes. Reported effects are standardized to percent changes per additional year of eligibility and are incorporated into a Marginal Value of Public Funds (MVPF) framework to compare benefits with government costs.

Greater Medicaid eligibility in utero and during childhood is consistently associated with lower rates of adult disability, chronic disease, hospitalizations, and mortality. Benefits extend beyond health to higher educational attainment, improved employment and earnings in adulthood, and reduced criminal involvement. Emerging evidence also points to intergenerational gains, with improved birth outcomes in the next generation. The longer-term reductions in public spending attributable to the effects of Medicaid on improved health and economic outcomes exceed the direct cost of expanded eligibility. Hence, prenatal and childhood Medicaid “pays for itself” by generating additional benefits for individuals and society.

Overall, early-life Medicaid coverage generates durable improvements in longevity, health, human capital, and economic productivity while reducing crime and intergenerational disadvantage. These findings underscore Medicaid’s role as both a public health investment and a fiscal bargain. Planned Medicaid cutbacks risk reversing decades of progress and will likely impose significant financial and social costs.

We examine child mental health treatment surrounding three school milestones in Taiwan: Middle school entry, high stakes testing for high school entrance, and college entrance exams. Using age cutoffs for school entry, we compare August-born to September-born children since the August-born reach each milestone one year earlier. Comparing adjacent cohorts of children born in the same month yields similar estimates. We find that entry into middle school increases mental health prescribing of antidepressant, anti-anxiety, and antipsychotic medications. Use of psychiatric medications falls sharply following high-stakes tests. Effects are stronger in counties where parents and children have higher educational aspirations.

We examine the impact of firearm violence on newborn health in the U.S. using two approaches. First, we analyze the “beltway sniper” attacks in 2002, leveraging both temporal and spatial variation to compare birth outcomes of exposed children to those unexposed. Second, we investigate in-utero exposure to mass shootings using national data. We find that exposure to these incidents during pregnancy increases the likelihood of very low-birthweight and very premature birth. These events carry a significant economic burden, with the beltway sniper attacks costing at least $155 million and mass shootings resulting in annual costs exceeding $75 million.

Doctors often treat similar patients differently, which affects health outcomes and medical spending. We assess the recent literature on doctor decision-making through the lens of a model that incorporates diagnostic and procedural skills, beliefs, incentives, and differences in patient pools. Decision-making is affected by beliefs, training, experience, peer effects, financial incentives, and time constraints. Interventions to improve decision-making include providing information, guidelines, and technologies like electronic medical records and algorithmic decision tools. Economists have made progress in understanding doctor decision-making, but applications of that knowledge to improving health care are still limited.

Many mental health disorders start in adolescence, and appropriate initial treatment may improve trajectories. But what is appropriate treatment? We use a large national database of insurance claims to examine the impact of initial mental health treatment on the outcomes of adolescent children over the next 2 years, where treatment is either consistent with US Food and Drug Administration guidelines, consistent with looser guidelines published by professional societies (gray area prescribing), or inconsistent with any guidelines (red-flag prescribing). We find that red-flag prescribing increases self-harm, use of emergency rooms, and health care costs, suggesting that treatment guidelines effectively scale up good treatment in practice.

Objective

To examine a 2018 rule change allowing pediatric providers to bill the child’s Medicaid ID for post-partum depression (PPD) screening of mothers conducted during well-child visits, and document its relationship with PPD treatment and infant hospitalizations.

Study setting and design

Screening rates during well-child visits are calculated at the zip code level and used in linear probability and Instrumental Variable (IV) models to examine increases in screening after the policy change and relate them to PPD treatment and infant hospitalizations.

Data sources and analytic sample

Individual-level Medicaid claims were used to compute PPD screening rates and measures of PPD treatment and infant hospitalization.

Principal findings

The policy was associated with increases in screening rates, although take up was uneven and overall screening rates remained low at 8.8%. There was little overall increase in treatment, although in zip codes in the top third of screening rates, higher screening was associated with 10.1% higher probability of maternal treatment. Zip codes with high fractions in poverty and/or minority had low screening rates, but screening was more likely to be associated with increases in treatment in these areas. There are no effects in the full sample of children, but among children above the poverty line, the observed increases in screening reduced the probability of infant hospitalization in the first six months by 7.7%.

Conclusions

The policy change had only limited success increasing screening, but increased screening could lead to more maternal PPD treatment and lower infant hospitalization rates if accompanied by expanded access to PPD treatment.

The child mental health crisis has been described as the "defining public health crisis of our time." This article addresses three myths about the crisis: (i) the idea that the crisis is new; (ii) the belief that increases in youth suicide mainly reflect deterioration in children's underlying mental health; and (iii) the myth that investments in children have little impact on children's mental health. In fact, the crisis has existed for decades, youth suicides vary asynchronously with other mental health measures and are impacted by external factors such as firearms legislation, and investments can improve child mental health and prevent suicide.