This paper estimates the effect of cost-sharing on the demand for children's and adolescents' use of medical care. We use a large population-wide registry dataset including detailed information on contacts with the health care system as well as family income. Two different estimation strategies are used: regression discontinuity design exploiting age thresholds above which fees are charged, and difference-in-differences models exploiting policy changes. We also estimate combined regression discontinuity difference-in-differences models that take into account discontinuities around age thresholds caused by factors other than cost-sharing. We find that when care is free of charge, individuals increase their number of doctor visits by 5-10%. Effects are similar in middle childhood and adolescence, and are driven by those from low-income families. The differences across income groups cannot be explained by other factors that correlate with income, such as maternal education.
Early intervention" has been a mantra in recent debates about human capital investment. Strong theoretical models motivate this focus by predicting that investment in children is most costeffective when they are young. The "Heckman curve" summarizes this idea visually (Heckman, 2006). However, hardly any reviews scrutinize this hypothesis empirically in modern welfare states such as those in Scandinavia that already invest heavily during early childhood. Any such review is ideally based on interventions conducted as randomized controlled trials (RCTs), set in the same welfare state, and comparable across ages through cost-standardized effects. This meta-analysis assembles cost-standardized effect estimates from 10 RCTs, including a total of 18 intervention arms and 30,578 participants (aged 1.5-24 years), conducted by the same research center in the Scandinavian welfare state of Denmark. These interventions show significant effects relative to their costs, despite the large baseline investment level. Interventions targeted at younger children tend to produce larger effects, consistent with the Heckman curve. However, variation in the effect size within age groups is as large as it is across age groups. This indicates that both the quality and timing of investments matter and that "early interventions" are not necessarily superior to later interventions.
We examine whether economic downturns are beneficial to health outcomes of newborn infants in developed countries. For this we use merged populationwide registers on health and economic and demographic variables, including the national medical birth register and intergenerational link registers from Sweden covering 1992-2004. We take a rigorous econometric approach that exploits regional variation in unemployment and compares babies born to the same parents so as to deal with possible selective fertility based on labour market conditions. We find that downturns are beneficial; an increase in the unemployment rate during pregnancy reduces the probability of having a birth weight less than 1,500 grams or of dying within 28 days of birth. Effects are larger in low socio-economic status households. Health improvements cannot be attributed to the parents' own employment status. Instead, the results suggest pathways more general than individual employment. * We thank the Editor Michele Pellizzari, two anonymous Referees, Anna Sjögren and participants at a seminar at the University of Aarhus and at EEA/ESEM and EALE conferences for useful comments and suggestions. Also, we thank Statistics Sweden and Socialstyrelsen for the use of the micro data registers and Hans-Martin von Gaudecker and Mårten Palme for their efforts in making these data accessible. We thank IFAU Uppsala, in particular Linus Liljeberg and Olof Åslund, for the data on unemployment rates.
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