The cost-effectiveness of developmental screenings: Evidence from a nationwide programme

Early intervention is considered the optimal response to developmental disorders in children. Any intervention presupposes the identification of affected children. Relatively little is known about the effectiveness of the standard practice of so-called developmental screenings. We evaluate a nationwide screening programme for preschoolers in Austria and the resulting interventions. Identification of treatment effects is determined by a birthday cutoff-based discontinuity in the eligibility for a financial incentive to participate in the screening. Assigned preschoolers - irrespective of their socio-economic status (SES) - are about 14 percentage points more likely to participate in the programme. For participants with high SES, we find little evidence for interventions and consistently no effect on healthcare costs in the long run. For participants with low SES preschoolers, we find evidence for substantial interventions, but only weak evidence for cost savings in the long run. We suggest that developmental screenings should focus on preschoolers with low SES and the institutional design should aim to minimize supply-side determined follow-up examinations with little to no benefit for the patient.