Family Spillovers of Serious Pediatric Illness: Evidence from Linked Claims Data

• In Event: Policy Perspectives on Relationship Stability and Divorce

Abstract

Each year, approximately 130,000 American children are diagnosed with a serious chronic or functionally-limiting condition, including cancers, neurological disorders, and organ failures. These diagnoses impose significant stress and strain on families, with effects that extend beyond the individual child to disrupt the daily lives, mental health, and health behaviors of parents and siblings. Parents may experience emotional stress from navigating their child's diagnosis and treatment, financial pressure from medical bills and reduced work hours, and competing demands that interfere with their own healthcare. Siblings may be affected by changes in household routines, emotional stress, and reduced parental attention. If families jointly produce health under shared resources and time constraints, a health shock to one member is also a shock to the household system, yet the magnitude and distribution of these spillovers remain understudied.

This paper investigates how a child's diagnosis with pediatric cancer affects the health and healthcare utilization of their parents and siblings. Using family-linked commercial claims from the Merative MarketScan database (2016–2024), I identify more than 3,000 families in which a child is newly diagnosed with cancer and build an event-time framework around the diagnosis. I use a stacked difference-in-differences and event study design that compares affected families to families facing the same diagnosis three years later, isolating within-family changes in mental health care use and other healthcare utilization. I examine outcomes across mental health care utilization, medications for mental health conditions, preventive care, and overall healthcare encounters to capture both psychological effects and potential crowd-out of other care.

In the year following a pediatric cancer diagnosis, mothers are 2.7 percentage points more likely to have any mental health care utilization, and they remain more likely to use mental health care than fathers or siblings across the two years post-diagnosis. Siblings also show increased mental health care use, though to a lesser extent, while fathers show no significant changes—possibly reflecting differences in caregiving roles or help-seeking behavior. Non-mental healthcare utilization, preventive care, and out-of-pocket spending do not show significant changes, suggesting that spillovers are concentrated in mental health rather than reflecting broader shifts in healthcare needs or crowd-out of other care.These findings highlight the importance of considering family spillovers in pediatric illness. They have implications for the design of family leave and caregiver support policies, and for valuations of medical innovation: ignoring family externalities may understate the true social returns to advances in pediatric treatment.

Author

• Mallory Dreyer, Indiana University
  Presenting Author