Association for Public Policy Analysis & Management

CHCs could have significant effects on patients’ health and productivity for a number of reasons. They help reduce financial and non-financial barriers to care by providing patients lower-cost and often free medical services. They also lower travel and waiting times as these centers tend to locate in disadvantaged neighborhoods and provide easy access to see primary care physicians. These channels could increase health care use, both on the extensive (previously unserved individuals receiving care) and intensive margins (individuals receiving better or more care). In the long run, preventative health care could impact health, wellbeing, and productivity. For instance, increases in use of preventive care and the early detection or management of chronic disease could lead to better long term health outcomes.

This paper uses the restricted Panel Survey of Income Dynamics and Bailey and Goodman-Bacon’s (2015) research design to examine the long-term impacts of CHCs. The research design exploits the CHCs county-level roll-out between 1964 and 1974, after accounting for time-invariant differences in county characteristics (county fixed effects) as well as changes in state policies and circumstances across time (state-by-year fixed effects). Following a growing body of research showing that early-life conditions can have life-long consequences (Barker, 1992; Cunha and Heckman, 2007; Almond et al., 2017), our study examines how greater exposure to preventative health care through CHCs in early-life affected long-term physical and mental health, health behaviors, and productivity measures such as education and labor market outcomes.

While the CHC literature is almost uniformly positive, it has been limited by data availability and the availability of research designs. First, most studies are case or localized studies with limited external validity or national studies with limited internal validity. Second, the literature tends to focus on specific types of CHC services (e.g., diabetes management) or subpopulations (e.g., infants). Thus, there are significant gaps regarding CHCs’ effects on adolescents or adults. Differences in the quality of CHC care (Hicks et al. 2006, Chin et al. 2000) and crowd-out of other health services also mean that the literature’s estimates of utilization may misstate CHCs’ impacts on health. Finally, no study considers CHCs’ longer-term effects on health or economic outcomes, such as education or wages, and even less so, on measures of life satisfaction.

Our study contributes to the literature by providing the first evidence on the potential impacts of early-life exposure to CHCs on individual’s long-term outcomes and by examining potential heterogeneous effects by age and demographic groups. Understanding how the effects of exposure to CHCs differ informs a better understanding of the programs’ potential mechanisms.