Association for Public Policy Analysis & Management

Prior research suggests that 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 UPK programs that emphasized developmental screening. We examine the effect of this program on the health 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. We find that the introduction of UPK increased the probability that a child was diagnosed with asthma or vision problems, or received treatment for hearing or vision problems, or an immunization or infectious disease screening during the prekindergarten year. UPK accelerated the diagnoses of vision problems. We find no 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 by accelerating the rate at which children are identified with conditions that could delay learning and cause behavioral problems.

In a secondary study, we examined the epidemiological pattern of influenza following the UPK rollout. Increasing the number of children in congregate settings could increase the speed or pattern of infectious outbreaks. Exploiting the age-cutoff for enrollment using a regression discontinuity framework, we apply both a survival analysis and harmonic regression to assess timing and infection rate. Despite the increase in children in congregate settings, we find no evidence of substantial changes in the pattern of seasonal influenza.