Willingness to Pay for Child Health Screening: Evidence from Lead Poisoning Prevention in Illinois

Disparities in utilization of preventative care persist across socioeconomic and racial groups in the US. Barriers to information, scheduling challenges, and transportation costs, appear to contribute to vaccine delay among disadvantaged families. Information and increases in the salience of disease risk are associated with increased immunization rates. In addition, improving access to treatment for a condition increases screening rates. In the absence of treatment opportunities, instead, information avoidance can be optimal.

Several policy levers could affect uptake of preventative care, and several barriers might counteract policy efforts to achieve optimal rates of utilization. I consider these factors in a unified setting to estimate parents’ willingness to pay (WTP) for preventative care and how it varies with exposure risk, information, treatment availability, and parents’ characteristics. Specifically, I focus on lead screening. While the effects of lead poisoning on IQ, educational attainment, and risk of criminal activity are considered irreversible, screening is important to remove the child from exposure.

I use data on over 3 million blood lead tests performed in Illinois between 2001 and 2016 and vital records for over 2 million children to estimate a model for screening demand as a function of five factors. First, I observe family characteristics in the birth records. Second, I estimate exposure risk from housing and pollution sources based on residence address, using parcel data, Toxic Release Inventory (TRI) data, and road maps. Third, I use distance to providers as a proxy for cost of screening to trace out WTP. Fourth, I study the role of access to remediation funding in determining demand for screening. Fifth, I assess how changes in the salience of lead hazards due to several “lead scares” affect the WTP estimates.

First, disadvantaged children have higher blood lead levels (BLLs): black children have BLLs that are 10% higher than the mean (0.21 μ g/mL), after controlling for zip code fixed effects, neighborhood income, and other local sources of exposure.

Second, the age of the housing stock is the strongest predictor of high blood lead levels: children living in pre1930 housing have BLLs 0.45 μ g/mL higher than the mean. In addition, living within 250 meters of a lead-emitting industrial facility is associated with an increase in BLLs of 0.001 per ton-year, while proximity to roads is not associated with BLLs. Importantly, children with higher exposure risk are also more likely to be screened.

Third, distance to providers leads to lower screening after controlling for demographic characteristics and zip code fixed effects. Being 20kms closer to a provider increases screening by 3.5%. Fourth, funding availability for remediation of lead-paint hazards increases screening by 4.4%.

Illinois requires universal screening in high risk zip codes. Even in these high risk zip codes, 20 percent of children are not screened. It is important to understand barriers to screening as states, including California, Illinois, and Maryland, consider switching to a universal screening system.