Family Spillover Effects of Marginal Diagnoses: The Case of ADHD
The health care system commonly relies on information about family medical history in the allocation of screenings and in diagnostic processes. At the same time, an emerging literature documents that treatment for “marginally diagnosed” patients often has minimal impacts. This paper shows that reliance on information about relatives' health can perpetuate marginal diagnoses across family members, thereby raising caseloads and health care costs, but without improving patient well-being. We study Attention Deficit Hyperactivity Disorder (ADHD), the most common childhood mental health condition, and document that the younger siblings and cousins of marginally diagnosed children are also more likely to be diagnosed with and treated for ADHD. Moreover, we find that the younger relatives of marginally diagnosed children have no better adult human capital and economic outcomes than the younger relatives of those who are less likely to be diagnosed. Our analysis points to a simple adjustment to physician protocol that can mitigate these marginal diagnosis spillovers.
We thank Amitabh Chandra, Liran Einav, Ben Handel, Andrew Hertzberg, Jon Kolstad, Adriana Lleras-Muney, Nolan Miller, Ziad Obermeyer, and seminar participants at Stanford University, the Electronic Health Economics Colloquium, American University, UC Berkeley, Philadelphia Federal Reserve, McGill University, Penn State, and the University of Copenhagen for helpful comments. We thank Katja Hoffman for excellent research assistance. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.