Providers, Places, and Children's Mental Health Care

Children's mental health is the defining public health crisis of our time. Using insurance claims for a national sample of 8 million privately insured children, I provide the first systematic quantification of the drivers of variation in children's mental health prescribing in the United States. I separate variation in pediatric ADHD medication and antidepressant prescribing due to differences in: 1) primary care provider (PCP) prescribing intensities, 2) regional practice environments, and 3) child health and demand. I find that eliminating differences in PCP prescribing intensities would reduce the variance of provider prescribing rates by 50 percent for ADHD medication and 65 percent for antidepressants. Geographic variation analyses understate the extent of treatment variation and the role of providers in driving overall treatment variation. I also find suggestive evidence that higher-quality PCPs tend to have higher ADHD prescribing intensities but lower antidepressant prescribing intensities.