The Economic Rationale for Investing in Children: A Focus on Child Care. Does Public Investment in Health Care Improve Child Health?


This section continues the discussion of expansions of health insurance for low-income women and children, and also discusses recent progress in improving compliance with vaccination schedules among preschoolers. An important lesson for child care policy which can be drawn from these two examples is that factors that limit takeup may also limit the cost-effectiveness of child care programs. Suppose for example, that the children who would gain the most from quality child care are the least likely to enroll. This could occur if disadvantaged parents are most likely to be put off by complicated applications or most likely to lack information about programs that might be beneficial for their children. More research on takeup of existing child care programs is necessary to assess the extent to which these concerns are valid.

The immunization example also illustrates the fact that simply eliminating financial barriers is not sufficient to insure that the most needy children receive services. Moreover, it illustrates the importance of outreach to providers as well as eligible families in order to insure that quality care is received.

Finally, the evidence suggests that while health insurance expansions improved child health, they did not do so in the most cost-effective way possible. This conclusion may also have implications for child care policy although it would be very difficult to assess the cost effectiveness of child care policy at present given the lack of systematic information about a broad range of child outcomes and/or costs. Greater attention should be paid to rigorous evaluation of child care policy. It is conceivable that some policies (such as encouraging very young children to use computers, or encouraging the placement of infants in center-based care) may turn out to do more harm than good on average. It would be wise to remember the physician's motto of "First, do no harm"!