We use data from the Veterans Administration to examine the efficacy of primary care providers (PCPs). Leveraging quasi-random assignment of veterans to PCPs, we measure effectiveness using ambulatory care sensitive conditions (ACSC) and hospitalizations/emergency department (ED) visits for mental health or circulatory conditions. PCPs variation along these dimensions predicts future outcomes. For example, a one standard deviation improvement in mental health effectiveness reduces patient risk of death by 3.8% and lowers costs by 4.4% over the next three years. More effective PCPs do more with less: their patients have fewer primary care visits, specialist referrals, lab panels, or imaging tests.

We study the effects of prenatal exposure to violent crime on infant health, using New York City crime records linked to mothers' addresses in birth records data. We address endogeneity of assault exposure with three strategies and find that in utero assault exposure significantly increases the incidence of adverse birth outcomes. We calculate that the annual social cost of assault during pregnancy in the United States is more than $3.8 billion. Since infant health predicts long-term wellbeing and disadvantaged women are disproportionately likely to be domestic abuse victims, violence in utero may be an important channel for intergenerational transmission of inequality.

Using a unique data set linking preschool blood lead levels, birth, school, and detention records for 125,000 children born between 1990 and 2004 in Rhode Island, we estimate the impact of lead on school suspension and juvenile detention. Sibling fixed-effect models suggest that omitted variables related to family disadvantage do not bias OLS estimates. However, measurement error does. We use IV methods that exploit local (within-neighborhood), variation in lead exposure deriving from road proximity and the deleading of gasoline. For boys, a 1 unit increase in lead increased the probability of suspension from school by 6% and detention by 57%.

We examine the effect of air pollution on school absences using administrative data for elementary and middle school children in 39 of the largest school districts in Texas merged with air quality information maintained by the Environmental Protection Agency. We address potentially confounding factors with a difference-in-difference-in-differences strategy that controls for persistent characteristics of schools, years, and attendance periods. Of the pollutants considered, we find that high carbon monoxide (CO) levels, even when below federal air quality standards, significantly increase absences. Our results suggest that the substantial decline in CO levels over the past two decades has yielded economically significant health benefits.

Most Americans are now in some form of managed care plan that restricts access to services in order to reduce costs. It is difficult to determine whether these restrictions affect health because individuals and firms self-select into managed care. We investigate the effect of managed care using a California law that required some pregnant women on Medicaid to enter managed care. We use a unique longitudinal database of California births in which we observe changes in the regime faced by individual mothers between births. We find that Medicaid managed care reduced the quality of prenatal care and increased low birth weight, prematurity, and neonatal death.