The Differential Effects of Insurance Mandates on Health Care Spending for Children's Autism Spectrum Disorder.

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TitleThe Differential Effects of Insurance Mandates on Health Care Spending for Children's Autism Spectrum Disorder.
Publication TypeJournal Article
Year of Publication2018
AuthorsCandon, MK, Barry, CL, Epstein, AJ, Marcus, SC, Kennedy-Hendricks, A, Xie, M, Mandell, DS
JournalMed Care
Date Published2018 03
KeywordsAdolescent, Autism Spectrum Disorder, Child, Child, Preschool, Female, Humans, Insurance Claim Review, Insurance Coverage, Insurance, Health, Male, Mandatory Programs, United States

OBJECTIVES: There is substantial variation in treatment intensity among children with autism spectrum disorder (ASD). This study asks whether policies that target health care utilization for ASD affect children differentially based on this variation. Specifically, we examine the impact of state-level insurance mandates that require commercial insurers to cover certain treatments for ASD for any fully-insured plan.METHODS: Using insurance claims between 2008 and 2012 from three national insurers, we used a difference-in-differences approach to compare children with ASD who were subject to mandates to children with ASD who were not. To allow for differential effects, we estimated quantile regressions that evaluate the impact of mandates across the spending distributions of three outcomes: (1) monthly spending on ASD-specific outpatient services; (2) monthly spending on ASD-specific inpatient services; and (3) quarterly spending on psychotropic medications.RESULTS: The change in spending on ASD-specific outpatient services attributable to mandates varied based on the child's level of spending. For those children with ASD who were subject to the mandate, monthly spending for a child in the 95th percentile of the ASD-specific outpatient spending distribution increased by $1460 (P<0.001). In contrast, the effect was only $2 per month for a child in the fifth percentile (P<0.001). Mandates did not significantly affect spending on ASD-specific inpatient services or psychotropic medications.CONCLUSIONS: State-level insurance mandates have larger effects for those children with higher levels of spending. To the extent that spending approximates treatment intensity and the underlying severity of ASD, these results suggest that mandates target children with greater service needs.

Alternate JournalMed Care
PubMed ID29287035
PubMed Central IDPMC5811382
Grant ListR01 MH096848 / MH / NIMH NIH HHS / United States