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The Effect of Medicaid on Children's Health: A Regression Discontinuity Approach

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  • de la Mata, D;

Abstract

In this paper I estimate the impact of Medicaid on children's health care utilization and their subsequent health outcomes. I estimate the causal effects using a Regression Discontinuity (RD) design. I exploit the discontinuity generated by Medicaid's eligibility rule, based on family income, on program participation rates. In contrast with a standard regression discontinuity approach, here there are multiple eligibility thresholds that vary across states. This feature allows me to estimate heterogeneous effects of the program at different income thresholds. Using data from the Panel Study of Income Dynamics (PSID) and its Child Development Study (CDS) supplement, I nd that the effects of Medicaid on measures of children's health are heterogeneous depending on the family income level. Negative impacts of Medicaid are generally observed for children of higher-income families ô€€€between 185% and 250% of the poverty line, while generally null or positive effects are observed for poorer children í¯€family income between 100% and 185% of the poverty line. A possible explanation for the heterogeneous impacts is the di erential e ect of Medicaid on preventive health care utilization. While I nd that Medicaid increases the use of preventive medical care among children with low family income, no signifcant e ects are observed among those with higher income. Another likely explanation for the observed e ects is that Medicaid induces higher-income families to drop private health insurance with access to better quality of health care, generating a negative e ect on children's health outcomes.

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Bibliographic Info

Paper provided by HEDG, c/o Department of Economics, University of York in its series Health, Econometrics and Data Group (HEDG) Working Papers with number 11/16.

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Date of creation: Jul 2011
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Handle: RePEc:yor:hectdg:11/16

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Postal: HEDG/HERC, Department of Economics and Related Studies, University of York, York, YO10 5DD, United Kingdom
Phone: (0)1904 323776
Fax: (0)1904 323759
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Web page: http://www.york.ac.uk/economics/postgrad/herc/hedg/
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Related research

Keywords: Health insurance; children's health; Medicaid; regression discontinuity design;

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References

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  1. Janet Currie, 2009. "Healthy, Wealthy, and Wise: Socioeconomic Status, Poor Health in Childhood, and Human Capital Development," Journal of Economic Literature, American Economic Association, vol. 47(1), pages 87-122, March.
  2. Lo Sasso, Anthony T. & Buchmueller, Thomas C., 2004. "The effect of the state children's health insurance program on health insurance coverage," Journal of Health Economics, Elsevier, vol. 23(5), pages 1059-1082, September.
  3. Janet Currie & Sandra Decker & Wanchuan Lin, 2008. "Has Public Health Insurance for Older Children Reduced Disparities in Access to Care and Health Outcomes?," NBER Working Papers 14173, National Bureau of Economic Research, Inc.
  4. Almond, Douglas & Currie, Janet, 2011. "Human Capital Development before Age Five," Handbook of Labor Economics, Elsevier.
  5. Imbens, Guido W. & Lemieux, Thomas, 2008. "Regression discontinuity designs: A guide to practice," Journal of Econometrics, Elsevier, vol. 142(2), pages 615-635, February.
  6. Janet Currie & Jonathan Gruber, 1995. "Health Insurance Eligibility, Utilization of Medical care, and Child Health," NBER Working Papers 5052, National Bureau of Economic Research, Inc.
  7. Jonathan Gruber & Kosali Simon, 2007. "Crowd-Out Ten Years Later: Have Recent Public Insurance Expansions Crowded Out Private Health Insurance?," NBER Working Papers 12858, National Bureau of Economic Research, Inc.
  8. Ham, John C. & Shore-Sheppard, Lara, 2005. "The effect of Medicaid expansions for low-income children on Medicaid participation and private insurance coverage: evidence from the SIPP," Journal of Public Economics, Elsevier, vol. 89(1), pages 57-83, January.
  9. Hahn, Jinyong & Todd, Petra & Van der Klaauw, Wilbert, 2001. "Identification and Estimation of Treatment Effects with a Regression-Discontinuity Design," Econometrica, Econometric Society, vol. 69(1), pages 201-09, January.
  10. David S. Lee & Thomas Lemieux, 2010. "Regression Discontinuity Designs in Economics," Journal of Economic Literature, American Economic Association, vol. 48(2), pages 281-355, June.
  11. Koch, Thomas G., 2013. "Using RD design to understand heterogeneity in health insurance crowd-out," Journal of Health Economics, Elsevier, vol. 32(3), pages 599-611.
  12. McCrary, Justin, 2008. "Manipulation of the running variable in the regression discontinuity design: A density test," Journal of Econometrics, Elsevier, vol. 142(2), pages 698-714, February.
  13. Cutler, David M & Gruber, Jonathan, 1996. "Does Public Insurance Crowd Out Private Insurance?," The Quarterly Journal of Economics, MIT Press, vol. 111(2), pages 391-430, May.
  14. Imbens, Guido W & Angrist, Joshua D, 1994. "Identification and Estimation of Local Average Treatment Effects," Econometrica, Econometric Society, vol. 62(2), pages 467-75, March.
  15. Sandra Decker, 2007. "Medicaid physician fees and the quality of medical care of Medicaid patients in the USA," Review of Economics of the Household, Springer, vol. 5(1), pages 95-112, March.
  16. Stephanie Riegg Cellini & Fernando Ferreira & Jesse Rothstein, 2010. "The Value of School Facility Investments: Evidence from a Dynamic Regression Discontinuity Design," The Quarterly Journal of Economics, MIT Press, vol. 125(1), pages 215-261, February.
  17. Arulampalam, W. & Robin A. Naylor & Jeremy P. Smith, 2002. "University of Warwick," Royal Economic Society Annual Conference 2002 9, Royal Economic Society.
  18. Wilbert van der Klaauw, 2002. "Estimating the Effect of Financial Aid Offers on College Enrollment: A Regression-Discontinuity Approach," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 43(4), pages 1249-1287, November.
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Cited by:
  1. Wittwer, Jérôme & Guthmuller, Sophie, 2012. "Means-tested complementary health insurance and healthcare utilisation in France: Evidence from a low-income population," Economics Papers from University Paris Dauphine 123456789/9533, Paris Dauphine University.

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