Panel Paper: Flint Water Contamination and Children’s Health: Analysis of Medicaid Claims

Thursday, November 8, 2018
Madison B - Mezz Level (Marriott Wardman Park)

*Names in bold indicate Presenter

Shooshan Danagoulian, Wayne State University, Daniel S Grossman, Cornell University and David Slusky, University of Kansas

This paper investigates the impact of the Flint water switch (and resulting lead exposure) on health care consumption. It expands upon our previous work (Grossman and Slusky 2017) which found that the water switch lowered the fertility rate by 12%. While the effect of lead exposure in children has been studied extensively, much less is known about medical care incurred by families of exposed children.

We have an exclusive agreement with the Michigan Department of Health and Human Services to use linked birth records and Medicaid claims for all children born 2013-2015. This data includes maternal address, demographics, any information on every procedure, test, physician office visit, and hospital interaction. Here we study four outcomes: 1: Adverse health outcomes from lead and stress; 2: Use of preventive care services. 3: Costs of additional medical care. 4: Public insurance enrollment.

First, we can identify adverse health outcomes associated with elevated levels of lead in the bloodstream and elevated stress levels in household. We hypothesize that children in Flint are likely to see an increased incidence of visits associated with suspected exposure to lead.

Second, increased community discussion, lead testing, and medical attention about children’s health outcomes may increase awareness of all types of preventive care, resulting in greater use. We will test this hypothesis by identifying all preventive care claims, including well-child visits, nutritional counseling, vaccinations, and flu shots.

Third, while additional preventive care visits may result in improved health of children in Flint, some unnecessary care will occur as well. The heightened anxiety about health is likely to result in overutilization of medical services. We will look for instances of unnecessary medical care, particularly in the context of the emergency department (ED).

Finally, individuals may be less likely to use a public source of health insurance after the water change because of a lack of trust in the government. Alternatively, individuals may be more likely to use Medicaid because they feel entitled to the care because health problems may have been caused by the water change. This may remove the stigma sometimes associated with public safety net programs.

The primary goal of these objectives is to generate a measure of the medical and financial burden for the community of Flint. A secondary goal is to identify the medical cost associated with the Flint water contamination borne by the taxpayers of the state of Michigan.

This paper is significant because it attempts to quantify the type of medical services received following exposure to a contaminated water source. Knowledge learned from this paper will directly benefit policy makers in determining how to counteract potential negative health effects of lead exposure in early childhood and health develop lead exposure information modules that inform parents and physicians about health problems to target following exposure.

Additionally, to the extent that we find medically inefficient care, these results can serve as an additional form of information for physicians when confronted with parents and children who are scared of the possible long-term effects of exposure to lead.