Working Paper: NBER ID: w23297
Authors: Kai Hong; Kacie Dragan; Sherry Glied
Abstract: Prior research suggests that high quality universal pre-kindergarten (UPK) programs can generate lifetime benefits, but the mechanisms generating these effects are not well-understood. In 2014, New York City made all 4-year-old children eligible for high-quality UPK programs that emphasized developmental screening. We examine the effect of this program on the health and healthcare utilization of children enrolled in Medicaid using a difference-in-regression discontinuity design that exploits both the introduction of UPK and the fixed age cut-off for enrollment. The introduction of UPK increased the probability that a child was diagnosed with asthma or with vision problems, received treatment for hearing or vision problems, or received a screening during the prekindergarten year. UPK accelerated the timing of diagnoses of vision problems. We do not find any increases in injuries, infectious diseases, or overall utilization. These effects are not offset by lower screening rates in the kindergarten year, suggesting that one mechanism through which UPK might generate benefits is that it accelerates the rate at which children are identified with conditions that could potentially delay learning and cause behavioral problems. We do not find significant effects of having a child who was eligible for UPK on mothers’ health, fertility, or healthcare utilization.
Keywords: universal prekindergarten; health outcomes; low-income children; Medicaid; New York City
JEL Codes: I10; I20; I28; J13
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| UPK program introduction (A21) | probability of children being diagnosed with asthma (J13) |
| UPK program introduction (A21) | probability of children being diagnosed with vision problems (J13) |
| UPK program introduction (A21) | likelihood of receiving treatment for hearing problems (I11) |
| UPK program introduction (A21) | likelihood of receiving treatment for vision problems (I24) |
| UPK program introduction (A21) | acceleration of the identification of health conditions that could impede learning and lead to behavioral issues (I24) |
| UPK program introduction (A21) | significant increases in injuries (J28) |
| UPK program introduction (A21) | significant increases in infectious diseases (I12) |
| UPK program introduction (A21) | significant increases in overall healthcare utilization (I11) |
| having a child eligible for UPK (J13) | mothers' health (I14) |
| having a child eligible for UPK (J13) | mothers' fertility (J13) |
| having a child eligible for UPK (J13) | mothers' healthcare utilization (I18) |