Janet Currie Publications

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.

This paper provides the first nationwide U.S. evidence on the effects of electric vehicle (EV) adoption on air quality and child health. Using county-level data from 2010–2021, we link EV registrations to air pollution, birth outcomes, and emergency department visits. Endogenous adoption is addressed using two-way fixed effects and an instrumental variables strategy exploiting the rollout of federally designated Alternative Fuel Corridors. Greater EV adoption significantly lowers nitrogen dioxide and improves infant and child health, reducing very low birth weight, prematurity, and asthma-related emergency visits. The largest health gains occur in high-pollution areas and exceed $1.2–$4.0 billion annually.

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.

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.

Black mothers with a trial of labor are 25 percent more likely to deliver by C-section than non-Hispanic White mothers. The gap is largest among mothers with the lowest risk and is reduced by only one-fifth when controlling for observed medical risk factors, sociodemographic characteristics, hospital, and physician or medical practice group. Remarkably, the gap disappears when performing a C-section is more costly due to a concurrent pre-labor C-section limiting surgical resources. This finding is consistent with provider discretion—rather than differences in unobserved medical risk—accounting for persistent racial disparities in delivery method. The additional intrapartum C-sections that occur among low-risk women when hospitals are unconstrained negatively impact infant health.

Increases in mental health diagnoses and suicidal behaviors in Emergency Departments are often cited as evidence of an accelerating child mental health crisis. We ask whether trends in ED visits provide an accurate picture of changes in U.S. child mental health. These measures have been profoundly affected by changing conventions about screening, defining, and coding of mental illness. We conclude that child mental health has been deteriorating, but not by the startling magnitudes suggested by jumps and trends in some measures such as suicidal ideation. Although reported suicidal behaviors rose 228% from 2006–2021, the true rise in mental health disorders is unlikely to exceed the 66% rise in youth suicide observed over the same period.

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.

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.

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.