How Does Access to Health Care Affect Teen Fertility and High School Dropout Rates? Evidence from School-based Health Centers
Children from low-income families face persistent barriers to accessing high-quality health care services. Previous research studies have examined the importance of expanding children's health insurance coverage, but there is little prior evidence concerning the impacts of directly expanding primary health care access to this population. We address this gap in the literature by exploring whether teenagers' access to primary health care influences their fertility and educational attainment. We study how the significant expansion of school-based health centers (SBHCs) in the United States since the early 1990's has affected teen fertility and high school dropout rates. Our results indicate that school-based health centers have a negative effect on teen birth rates: adding services equivalent to the average SBHC reduces the 15-18 year old birth rate by 5%. The effects are largest among younger teens and among African Americans and Hispanics. However, primary care health services do not reduce high school dropout rates by very much despite the sizable reductions in teen birth rates
We would like to thank the National Alliance on School-based Health Care for allowing us access to their data and for their assistance in using the data. We thank Will White, Nicolas Ziebarth, Samuel Kleiner, Janet Currie, Phil Levine and Anjali Adukia for helpful discussions, as well as seminar participants at the CESifo conference on economics of education, the NBER Summer Institute Children's Working Group, the New York Federal Reserve Bank Economics of Education Seminar, University of Chicago, Michigan State University, New York University, Bocconi University, University of Wisconsin, University of Oklahoma, and the Association for Education Finance and Policy Annual Meeting. We also gratefully acknowledge funding from the Department of Policy Analysis and Management at Cornell University for this project The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.