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Yan X, Li Y, Li Q, Li Q, Xu G, Lu J, Yang W. Prevalence of Autism Spectrum Disorder Among Children and Adolescents in the United States from 2021 to 2022. J Autism Dev Disord 2024:10.1007/s10803-024-06390-7. [PMID: 38778000 DOI: 10.1007/s10803-024-06390-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE The prevalence of autism spectrum disorder (ASD) among children and adolescents seem to be high in countries around the world, and it's worth understanding the latest prevalence and trends of ASD in children and adolescents. The purpose of this study was to examine the latest prevalence and decade trend of ASD among individuals aged 3-17 years in the United States. METHODS A total of 13,198 individuals aged 3-17 years were included. Annual data were examined from the National Health Interview Survey (2021-2022). Weighted prevalence for each of the selected developmental disabilities were calculated. RESULTS This cross-sectional study estimated the weighted prevalence of autism spectrum disorder were 3.05, 3.79, and 3.42% among individuals aged 3-17 years in the US in 2021, 2022, and the 2-year overall, respectively. We also observed a decade-long upward trend even after adjusting for demographic characteristics (P for trend < .05). CONCLUSION The results of this study showed that the prevalence of ASD among children and adolescents aged 3-17 years in the United States remained high and has increased over the past decade. The further investigation is necessary to evaluate potential modifiable risk factors and causes of ASD.
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Affiliation(s)
- Xiaofang Yan
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Yanmei Li
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Qishan Li
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Qian Li
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Guifeng Xu
- Department of Pediatrics, The First Affiliated Hospital, University of Science and Technology of China, Hefei, China
| | - Jinhua Lu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangdong Province, Guangzhou Medical University, Guangzhou, 510623, China.
| | - Wenhan Yang
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China.
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Sesay MM, McCracken CE, Stewart C, Simon G, Penfold R, Ahmedani B, Rossom RC, Lu CY, Beck A, Coleman KJ, Daida Y, Lynch FL, Zeber J, Copeland L, Owen-Smith A. Short report: Transition to International Classification of Diseases, 10th Revision and the prevalence of autism in a cohort of healthcare systems. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1316-1321. [PMID: 38240250 PMCID: PMC11065615 DOI: 10.1177/13623613231220687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
LAY ABSTRACT Currently, the prevalence of autism spectrum disorder (henceforth "autism") is 1 in 36, an increasing trend from previous estimates. In 2015, the United States adopted a new version (International Classification of Diseases, 10th Revision) of the World Health Organization coding system, a standard for classifying medical conditions. Our goal was to examine how the transition to this new coding system impacted autism diagnoses in 10 healthcare systems. We obtained information from electronic medical records and insurance claims data from July 2014 through December 2016 for each healthcare system. We used member enrollment data for 30 consecutive months to observe changes 15 months before and after adoption of the new coding system. Overall, the rates of autism per 1000 enrolled members was increasing for 0- to 5-year-olds before transition to International Classification of Diseases, 10th Revision and did not substantively change after the new coding was in place. There was variation observed in autism diagnoses before and after transition to International Classification of Diseases, 10th Revision for other age groups. The change to the new coding system did not meaningfully affect autism rates at the participating healthcare systems. The increase observed among 0- to 5-year-olds is likely indicative of an ongoing trend related to increases in screening for autism rather than a shift associated with the new coding.
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Affiliation(s)
- Musu M Sesay
- Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, GA, USA
| | | | - Christine Stewart
- Kaiser Permanente Washington, Health Research Institute, Seattle, WA, USA
| | - Gregory Simon
- Kaiser Permanente Washington, Health Research Institute, Seattle, WA, USA
| | - Robert Penfold
- Kaiser Permanente Washington, Health Research Institute, Seattle, WA, USA
| | - Brian Ahmedani
- Henry Ford Health System, Center for Health Policy & Health Services Research, Detroit, MI, USA
| | | | - Christine Y Lu
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, USA
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | - Yihe Daida
- Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Frances L Lynch
- Kaiser Permanente Northwest, Center of Health Research, Portland, OR, USA
| | - John Zeber
- University of Massachusetts, Department of Health Promotion & Policy, Amherst, MA, USA
| | - Laurel Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
| | - Ashli Owen-Smith
- Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, GA, USA
- Georgia State University, School of Public Health, Atlanta, GA, USA
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Guertin JR, Gilbert-Ouimet M, Dugas M, Carnovale V, Jalbert L, Svyntozelska O, Demers J, Matteau L, Bergeron F, LeBlanc A. Methods used to account for caregivers' sex and gender within studies examining the financial burden of caregivers of children and adolescents : Results from a scoping review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:35-53. [PMID: 38298908 PMCID: PMC10829241 DOI: 10.2147/ceor.s443077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
Background Interest in the financial burden of informal caregivers has been growing. Unfortunately, it remains unclear which method(s) should be used when quantifying this burden. Purpose We conducted a scoping review aimed at identifying which methods have been used to conduct such work and quantified their performance. We were also interested in examining how sex and gender considerations were considered within selected studies. Data Sources Using a standardized approach, we identified studies published between 2012 and 2022 that aimed to document the financial burden of caregivers to child and adolescent patients. Our search strategy was applied to the MEDLINE, Embase, CINHAL, and Academic Search Premier databases. Study Selection Manuscript selection was performed by pairs of reviewers. Data Extraction Data extraction was performed by one reviewer with a second reviewer performing quality control. Results were reported using a narrative approach. Data Synthesis We identified 9801 unique citations, of which 200 were included in our review. Selected studies covered various disease area (eg, infection/parasitic diseases [n = 31, 16%]) and included quantitative (n = 180, 90%), qualitative (n = 4, 2%) and mixed study designs (n = 16, 8%). Most studies (n = 182, 91%) used questionnaires/surveys, either alone or in combination with other methods, to assess caregivers' financial burden. Less than half (n = 93, 47%) of studies reported on caregivers' sex and none reported on their gender. Conclusion We conducted an unrestricted review of published studies examining caregiver's financial burden which allowed us to identify general methodological trends observed in this literature. We believe this work may help improve future studies focusing on this important issue.
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Affiliation(s)
- Jason Robert Guertin
- Centre de recherche du Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche en organogénèse expérimentale de l’Université Laval/LOEX, Quebec City, Quebec, Canada
| | - Mahée Gilbert-Ouimet
- Centre de recherche du Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
- Department of Health Sciences, Université du Québec À Rimouski, Levis, Quebec, Canada
| | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Valérie Carnovale
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Laura Jalbert
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Olha Svyntozelska
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Juliette Demers
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Léonie Matteau
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Department of Health Sciences, Université du Québec À Rimouski, Levis, Quebec, Canada
| | - Frédéric Bergeron
- Bibliothèque-Direction des services-conseils, Université Laval, Quebec City, Quebec, Canada
| | - Annie LeBlanc
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
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Classifying children with ASD by service utilization and treatment type: A cluster analysis of a nationally representative United States survey. Acta Psychol (Amst) 2023; 232:103800. [PMID: 36502602 DOI: 10.1016/j.actpsy.2022.103800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND If there are patterns of the distribution of services and treatments across the population of people with ASD, these patterns should be based along clinical characteristics or other service needs and not sociodemographic characteristics unrelated to evidence-based care. We examined how individuals in a broad, nationally representative sample "grouped together" based on service utilization and services needed but not covered by insurance. By understanding various treatment patterns, clinicians, researchers, policymakers, and self-advocates and their families can better advocate for high-quality, evidence-based services to be provided equitably. METHODS Using the 2011 Survey of Pathways to Diagnosis and Services, a cluster analysis was performed to explore patterns in this population based on medication use, private services use, school-based service use, and services not covered by insurance. Differences in clusters were then explored through multinomial logistic regression. RESULTS Six clusters emerged, showing differences in the level of service/medication usage and insurance coverage. Differences across clusters were associated with the level of functional limitation and age at ASD diagnosis. Disparities by insurance type, functional limitation, and age at diagnosis exist among patterns of ASD service provision. CONCLUSIONS Our analysis showed that intervention for children with ASD can be across several scales - high and low users of services (both private and school-based), high and low users of medications, and high and low levels of reported non-covered services. The differences were clustered in multiple ways. Further research should incorporate longitudinal and nationally representative data to explore these relationships further.
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Hampton M, McNamara S. The impact of educational rewards on the diagnosis of autism spectrum disorder. ECONOMICS AND HUMAN BIOLOGY 2022; 47:101188. [PMID: 36272247 DOI: 10.1016/j.ehb.2022.101188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/19/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that affects social interactions and communication. The prevalence of ASD has risen dramatically in recent years, but the underlying factors leading to this rise are not clear. In this paper, we test whether changes in state-level educational policy that impact school-level resources are associated with the rise in ASD diagnostic prevalence. Early identification of ASD can improve an array of outcomes for children, and school systems play an important role with identification of the condition. It is plausible that children attending schools with better resources from state governments are more likely to receive an ASD diagnosis and presumably appropriate services. We focus on one educational policy in particular, state-level rewards, which consist of a monetary transfer from state governments to school districts. To test the impact of educational rewards on ASD diagnosis, we rely on policy variation across states and time and estimate both two-way fixed effects (TWFE) models alongside recently advanced methods in the difference-in-differences (DiD) literature. Under a baseline TWFE specification we estimate that rewards policies are associated with a 18.46% increase in ASD diagnosis. Further, using DiD methods that account for bias in settings of differential policy timing, we find that the magnitude of the effect increases to 24.8%. We believe these findings to be suggestive evidence that educational rewards policies improved the likelihood of detection and diagnosis of ASD.
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Affiliation(s)
- Matt Hampton
- Department of Accounting, Finance, and Economics, Austin Peay State University, College of Business, Clarksville, TN 37040, USA.
| | - Scott McNamara
- Department of Kinesiology, University of New Hampshire, College of Health and Human Services, Durham, NH 03824.
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Acton R, Imberman S, Lovenheim M. Do Health Insurance Mandates Spillover to Education? Evidence from Michigan's Autism Insurance Mandate. JOURNAL OF HEALTH ECONOMICS 2021; 80:102489. [PMID: 34536824 DOI: 10.1016/j.jhealeco.2021.102489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 06/15/2021] [Accepted: 06/19/2021] [Indexed: 06/13/2023]
Abstract
Social programs and mandates are usually studied in isolation, but unintended spillovers to other areas can impact individual behavior and social welfare. We examine the presence of spillovers from health care policy to the education sector by studying how health insurance coverage affects the education of students with Autism Spectrum Disorder (ASD). We leverage a state mandate that increased insurance coverage of ASD-related services, which often are provided by both the private sector and within public schools. The mandate primarily affected coverage for children with private health insurance, so we proxy for private insurance coverage with students' economic disadvantage status and estimate effects via triple-differences. While we find little change in ASD identification, the mandate crowds-out special education supports for students with ASD. A lack of short-run impact on achievement supports our crowd-out interpretation and indicates that the mandate had little net effect on the academic achievement of ASD students.
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Assessing the Healthy People 2020 Objective to Expand Early Treatment Receipt Among a National Sample of Children with Autism Spectrum Disorder. J Dev Behav Pediatr 2021; 41:359-365. [PMID: 32168260 DOI: 10.1097/dbp.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the progress of the Healthy People 2020 (HP2020) objective to increase the proportion of children with autism spectrum disorder (ASD) who receive treatment by 48 months old and to examine the relationship between predisposing, enabling, and need factors and age of initial treatment receipt. METHOD We used data from the National Survey of Children's Health, 2016 to 2017, a nationally representative study of US children. Our sample included children aged 3 to 17 years old with ASD who received treatment (N = 1333). We conducted χ goodness of fit tests and logistic regression. RESULTS The HP2020 objective to enroll 57.6% of 8-year-old children with ASD in treatment by 48 months old was not met (40.9%). Among 3- to 5-year-old children with ASD, the proportion who received treatment by 48 months old was more than double that of 8-year-old children (88.3%). We detected social inequities and significant differences by provider type and state mandate. CONCLUSION Research with larger samples is needed to continue tracking progress. If the goal continues not to be met, work will be required to explain stagnation and to inform additional targeted efforts to reduce the age of initial treatment.
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Grosse SD, Ji X, Nichols P, Zuvekas SH, Rice CE, Yeargin-Allsopp M. Spending on Young Children With Autism Spectrum Disorder in Employer-Sponsored Plans, 2011-2017. Psychiatr Serv 2021; 72:16-22. [PMID: 33076792 PMCID: PMC7879423 DOI: 10.1176/appi.ps.202000099] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Rapid increases in the prevalence of autism spectrum disorder (ASD) and increased access to intensive behavioral interventions have likely increased health care spending. This study estimated recent changes in spending among privately insured children with and without current ASD. METHODS A repeated cross-sections analysis of 2011-2017 claims data from large-employer-sponsored health plans assessed changes in annual expenditures by service type for children ages 3-7 enrolled for ≥1 year and with two or more claims with ASD billing codes within a calendar year and for all other children. RESULTS Mean spending per child with a current-year ASD diagnosis increased by 51% in 2017 U.S. dollars, from roughly $13,000 in 2011 to $20,000 in 2017. Among children who did not meet the current-year ASD case definition, per-child spending increased by 8%. Spending on children with ASD accounted for 41% of spending growth for children ages 3-7 during 2011-2017. Outpatient behavioral intervention-related spending per child with ASD increased by 376%, from $1,746 in 2011 to $8,317 in 2017; spending on all other services increased by 2%. Their share of behavioral intervention-related spending increased from 13.2% in 2011 to 41.7% in 2017. In 2011, 2.5% of children with current-year ASD diagnoses incurred ≥$20,000 in outpatient behavioral intervention-related spending, which increased to 14.4% in 2017. CONCLUSIONS During 2011-2017, spending increased six times as much for privately insured children ages 3-7 with current-year ASD as for children without ASD, largely from increased behavioral intervention-related spending. One in seven children received at least $20,000 in services in 2017.
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Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta (Grosse, Nichols, Yeargin-Allsopp); Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (Ji); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland (Zuvekas); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Rice). This work was performed when Dr. Ji was a Prevention Effectiveness Fellow at the CDC
| | - Xu Ji
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta (Grosse, Nichols, Yeargin-Allsopp); Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (Ji); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland (Zuvekas); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Rice). This work was performed when Dr. Ji was a Prevention Effectiveness Fellow at the CDC
| | - Phyllis Nichols
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta (Grosse, Nichols, Yeargin-Allsopp); Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (Ji); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland (Zuvekas); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Rice). This work was performed when Dr. Ji was a Prevention Effectiveness Fellow at the CDC
| | - Samuel H Zuvekas
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta (Grosse, Nichols, Yeargin-Allsopp); Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (Ji); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland (Zuvekas); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Rice). This work was performed when Dr. Ji was a Prevention Effectiveness Fellow at the CDC
| | - Catherine E Rice
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta (Grosse, Nichols, Yeargin-Allsopp); Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (Ji); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland (Zuvekas); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Rice). This work was performed when Dr. Ji was a Prevention Effectiveness Fellow at the CDC
| | - Marshalyn Yeargin-Allsopp
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta (Grosse, Nichols, Yeargin-Allsopp); Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (Ji); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland (Zuvekas); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Rice). This work was performed when Dr. Ji was a Prevention Effectiveness Fellow at the CDC
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Abstract
This review aims to summarize evidence from published articles regarding the economic burdens on parents of children diagnosed with autism to elaborate on current research status, discern key findings and provide suggestions for future studies. A total of 1024 records were identified through our systematic literature research, and 33 studies were included in the review. The 33 included studies reported findings from 10 different countries around the world. These articles (published from 2003 to 2017) used a variety of research methods, including quantitative (n = 26), qualitative (n = 4), and mixed (n = 3) study designs. In summary, parents of autistic children were susceptible to adverse employment impacts and increased financial burdens, especially mothers. More attention should be given to the development of appropriate medical resource allocation and the alleviation of economic burdens on parents of children with autism.
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So M, McCord RF, Kaminski JW. Policy Levers to Promote Access to and Utilization of Children's Mental Health Services: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:334-351. [PMID: 30604005 DOI: 10.1007/s10488-018-00916-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Policies have potential to help families obtain behavioral healthcare for their children, but little is known about evidence for specific policy approaches. We reviewed evaluations of select policy levers to promote accessibility, affordability, acceptability, availability, or utilization of children's mental and behavioral health services. Twenty articles met inclusion criteria. Location-based policy levers (school-based services and integrated care models) were associated with higher utilization and acceptability, with mixed evidence on accessibility. Studies of insurance-based levers (mental health parity and public insurance) provided some evidence for affordability outcomes. We found no eligible studies of workforce development or telehealth policy levers, or of availability outcomes.
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Affiliation(s)
- Marvin So
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway MS-E88, Atlanta, 30341, GA, USA. .,Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
| | - Russell F McCord
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway MS-E88, Atlanta, 30341, GA, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Jennifer W Kaminski
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway MS-E88, Atlanta, 30341, GA, USA
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Candon MK, Barry CL, Marcus SC, Epstein AJ, Kennedy-Hendricks A, Xie M, Mandell DS. Insurance Mandates and Out-of-Pocket Spending for Children With Autism Spectrum Disorder. Pediatrics 2019; 143:peds.2018-0654. [PMID: 30541827 PMCID: PMC6317558 DOI: 10.1542/peds.2018-0654] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The health care costs associated with treating autism spectrum disorder (ASD) in children can be substantial. State-level mandates that require insurers to cover ASD-specific services may lessen the financial burden families face by shifting health care spending to insurers. METHODS We estimated the effects of ASD mandates on out-of-pocket spending, insurer spending, and the share of total spending paid out of pocket for ASD-specific services. We used administrative claims data from 2008 to 2012 from 3 commercial insurers, and took a difference-in-differences approach in which children who were subject to mandates were compared with children who were not. Because mandates have heterogeneous effects based on the extent of children's service use, we performed subsample analyses by calculating quintiles based on average monthly total spending on ASD-specific services. The sample included 106 977 children with ASD across 50 states. RESULTS Mandates increased out-of-pocket spending but decreased the share of spending paid out of pocket for ASD-specific services on average. The effects were driven largely by children in the highest-spending quintile, who experienced an average increase of $35 per month in out-of-pocket spending (P < .001) and a 4 percentage point decline in the share of spending paid out of pocket (P < .001). CONCLUSIONS ASD mandates shifted health care spending for ASD-specific services from families to insurers. However, families in the highest-spending quintile still spent an average of >$200 per month out of pocket on these services. To help ease their financial burden, policies in which children with higher service use are targeted may be warranted.
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Affiliation(s)
- Molly K. Candon
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine,,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Colleen L. Barry
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and,Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Steven C. Marcus
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine,,School of Social Policy and Practice, and,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Andrew J. Epstein
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Alene Kennedy-Hendricks
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Ming Xie
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine
| | - David S. Mandell
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine,,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Wang L, Ma J, Dholakia R, Howells C, Lu Y, Chen C, Li R, Murray M, Leslie D. Changes in Healthcare Expenditures After the Autism Insurance Mandate. RESEARCH IN AUTISM SPECTRUM DISORDERS 2019; 57:97-104. [PMID: 31440305 PMCID: PMC6706245 DOI: 10.1016/j.rasd.2018.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND In recent years, most U.S. states have passed autism mandates requiring private insurers to cover autism spectrum disorders (ASD). Little is known about the post-mandate changes in healthcare expenditures. METHOD This study utilized 2006-2012 de-identified insurance claims data from the largest insurer in Pennsylvania (PA), where the mandate went into effect in 2009. Healthcare expenditures were defined as the amount the insurer paid for healthcare services and were adjusted to 2012 price level. A mixed model approach was used to analyze the expenditures. RESULTS A total of 9,471 children with ASD were included in the study. Although the pre-mandate total expenditures per child with ASD were similar, the post-mandate expenditures significantly increased for groups subject to the autism mandate (87% increase from $7,754 in 2008 to $14,486 in 2010) compared to the exempt groups (27% increase from $7,238 to $9,171). By insurance type, the change from 2008 to 2010 in ASD-related expenditures per child with ASD was $8,439 for fully insured large employer sponsored plans and $43 for the Children's Health Insurance Program (CHIP), both subject to the PA mandate; and $2,631 for the self-insured, $980 for small-employers, and $-92 for individual plans, all of which are exempt from the mandate. These increases were due to outpatient services but not inpatient or drug costs. CONCLUSIONS Healthcare expenditures increased significantly following the PA autism mandate. Nonexempt, large employer groups had the largest increase in spending. Some exempt, self-insured companies may have voluntarily covered ASD services, leading to a moderate increase.
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Affiliation(s)
- Li Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- Department of Statistics, Penn State University, University Park, PA
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA
| | - Junyi Ma
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Ruchita Dholakia
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Callie Howells
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Yun Lu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Chen Chen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Runze Li
- Department of Statistics, Penn State University, University Park, PA
| | - Michael Murray
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA
| | - Douglas Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA
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13
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Shahidullah JD, Azad G, Mezher KR, McClain MB, McIntyre LL. Linking the Medical and Educational Home to Support Children With Autism Spectrum Disorder: Practice Recommendations. Clin Pediatr (Phila) 2018; 57:1496-1505. [PMID: 29719986 DOI: 10.1177/0009922818774344] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Children with autism spectrum disorder (ASD) present with complex medical problems that are often exacerbated by a range of other intellectual and psychiatric comorbidities. These children receive care for their physical and mental health from a range of providers within numerous child-serving systems, including their primary care clinic, school, and the home and community. Given the longitudinal nature in which care is provided for this chronic disorder, it is particularly necessary for services and providers to coordinate their care to ensure optimal efficiency and effectiveness. There are 2 primary venues that serve as a "home" for coordination of service provision for children with ASD and their families-the "medical home" and the "educational home." Unfortunately, these venues often function independently from the other. Furthermore, there are limited guidelines demonstrating methods through which pediatricians and other primary care providers (PCPs) can coordinate care with schools and school-based providers. The purpose of this article is 2-fold: (1) we highlight the provision of evidence-based care within the medical home and educational home and (2) we offer practice recommendations for PCPs in integrating these systems to optimally address the complex medical, intellectual, and psychiatric symptomology affected by autism.
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Affiliation(s)
- Jeffrey D Shahidullah
- 1 Rutgers University, New Brunswick, NJ, USA and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Gazi Azad
- 2 Johns Hopkins University, Baltimore, MD, USA and Kennedy Krieger Institute, Baltimore, MD, USA
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Barry CL, Epstein AJ, Marcus SC, Kennedy-Hendricks A, Candon MK, Xie M, Mandell DS. Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder. Health Aff (Millwood) 2018; 36:1754-1761. [PMID: 28971920 DOI: 10.1377/hlthaff.2017.0515] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Forty-six states and the District of Columbia have enacted insurance mandates that require commercial insurers to cover treatment for children with autism spectrum disorder (ASD). This study examined whether implementing autism mandates altered service use or spending among commercially insured children with ASD. We compared children age twenty-one or younger who were eligible for mandates to children not subject to mandates using 2008-12 claims data from three national insurers. Increases in service use and spending attributable to state mandates were detected for all outcomes. Mandates were associated with a 3.4-percentage-point increase in monthly use and a $77 increase in monthly spending on ASD-specific services. Effects were larger for younger children and increased with the number of years since mandate implementation. These increases suggest that state mandates are an effective tool for broadening access to autism treatment under commercial insurance.
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Affiliation(s)
- Colleen L Barry
- Colleen L. Barry is the Fred and Julie Soper Professor and Chair of the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, and codirector of the Johns Hopkins Center for Mental Health and Addiction Policy Research, in Baltimore, Maryland
| | - Andrew J Epstein
- Andrew J. Epstein is scientific director of Medicus Economics, in Philadelphia, Pennsylvania
| | - Steven C Marcus
- Steven C. Marcus is a research associate professor in the School of Social Policy and Practice, University of Pennsylvania, in Philadelphia
| | - Alene Kennedy-Hendricks
- Alene Kennedy-Hendricks is an assistant scientist in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Molly K Candon
- Molly K. Candon is a postdoctoral fellow at the Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania
| | - Ming Xie
- Ming Xie is a data analyst at the Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania
| | - David S Mandell
- David S. Mandell is director of the Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania
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15
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Doshi P, Tilford JM, Ounpraseuth S, Kuo DZ, Payakachat N. Do Insurance Mandates Affect Racial Disparities in Outcomes for Children with Autism? Matern Child Health J 2018; 21:351-366. [PMID: 27449784 DOI: 10.1007/s10995-016-2120-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective The study investigated whether state mandates for private insurers to provide services for children with autism influence racial disparities in outcomes. Methods The study used 2005/2006 and 2009/2010 waves of the National Survey of Children with Special Health Care Needs. Children with a current diagnosis of autism were included in the sample. Children residing in 14 states and the District of Columbia that were not covered by the mandate in the 2005/2006 survey, but were covered in the 2009/2010 survey, served as the mandate group. Children residing in 32 states that were not covered by a mandate in either wave served as the comparison group. Outcome measures assessed included care quality, family economics, and child health. A difference-in-difference-in-differences (DDD) approach was used to assess the impact of the mandates on racial disparities in outcomes. Results Non-white children had less access to family-centered care compared to white children in both waves of data, but this difference was not apparent across mandate and comparison states as only the comparison states had significant differences. Parents of non-white children reported paying less in annual out-of-pocket expenses compared to parents of white children across waves and groups. DDD estimates did not provide evidence that the mandates had statistically significant effects on improving or worsening racial disparities for any outcome measure. Conclusions This study did not find evidence that state mandates on private insurers affected racial disparities in outcomes for children with autism.
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Affiliation(s)
| | - J Mick Tilford
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Songthip Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Dennis Z Kuo
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nalin Payakachat
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 W. Markham St, 522, Little Rock, AR, USA.
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16
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Leslie DL, Iskandarani K, Velott DL, Stein BD, Mandell DS, Agbese E, Dick AW. Medicaid Waivers Targeting Children With Autism Spectrum Disorder Reduce The Need For Parents To Stop Working. Health Aff (Millwood) 2018; 36:282-288. [PMID: 28167717 DOI: 10.1377/hlthaff.2016.1136] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Several states have passed Medicaid home and community-based services waivers that expand eligibility criteria and available services for children with autism spectrum disorder. Although previous research has shown considerable variation in these waivers, little is known about the programs' impact on parents' workforce participation. We used nationally representative survey data combined with detailed information on state Medicaid waiver programs to determine the effects of waivers on whether parents of children with autism spectrum disorder had to stop working because of the child's condition. Increases in the Medicaid home and community-based services waiver cost limit and enrollment limit significantly reduced the likelihood that a parent had to stop working, although the results varied considerably by household income level. These findings suggest that the Medicaid waivers are effective policies to address the care-related needs of children with autism spectrum disorder.
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Affiliation(s)
- Douglas L Leslie
- Douglas L. Leslie is a professor at the Penn State College of Medicine, in Hershey
| | - Khaled Iskandarani
- Khaled Iskandarani is a research data analyst at the Penn State College of Medicine
| | - Diana L Velott
- Diana L. Velott is a senior instructor at the Penn State College of Medicine
| | - Bradley D Stein
- Bradley D. Stein is a senior behavioral and policy sciences researcher at the RAND Corporation in Pittsburgh, Pennsylvania
| | - David S Mandell
- David S. Mandell is director of the Center for Mental Health Policy and Services Research at the Perelman School of Medicine, University of Pennsylvania, in Philadelphia
| | - Edeanya Agbese
- Edeanya Agbese is a project manager at the Penn State College of Medicine
| | - Andrew W Dick
- Andrew W. Dick is a senior economist at the RAND Corporation in Boston, Massachusetts
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Candon MK, Barry CL, Epstein AJ, Marcus SC, Kennedy-Hendricks A, Xie M, Mandell DS. The Differential Effects of Insurance Mandates on Health Care Spending for Children's Autism Spectrum Disorder. Med Care 2018; 56:228-232. [PMID: 29287035 PMCID: PMC5811382 DOI: 10.1097/mlr.0000000000000863] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Molly K Candon
- Leonard Davis Institute of Health Economics
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Colleen L Barry
- Leonard Davis Institute of Health Economics
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Andrew J Epstein
- Leonard Davis Institute of Health Economics
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steven C Marcus
- Leonard Davis Institute of Health Economics
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA
| | | | - Ming Xie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David S Mandell
- Leonard Davis Institute of Health Economics
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Fiorio CV, Gorli M, Verzillo S. Evaluating organizational change in health care: the patient-centered hospital model. BMC Health Serv Res 2018; 18:95. [PMID: 29422045 PMCID: PMC5806258 DOI: 10.1186/s12913-018-2877-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 01/23/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND An increasing number of hospitals react to recent demographic, epidemiological and managerial challenges moving from a traditional organizational model to a Patient-Centered (PC) hospital model. Although the theoretical managerial literature on the PC hospital model is vast, quantitative evaluations of the performance of hospitals that moved from the traditional to the PC organizational structure is scarce. However, quantitative analysis of effects of managerial changes is important and can provide additional argument in support of innovation. METHODS We take advantage of a quasi-experimental setting and of a unique administrative data set on the population of hospital discharge charts (HDCs) over a period of 9 years of Lombardy, the richest and one of the most populated region of Italy. During this period three important hospitals switched to the PC model in 2010, whereas all the others remained with the functional organizational model. This allowed us to develop a difference-in-difference analysis of some selected measures of efficiency and effectiveness for PC hospitals focusing on the "between-variability" of the 25 major diagnostic categories (MDCs) in each hospital and estimating a difference-in-difference model. RESULTS We contribute to the literature that addresses the evaluation of healthcare and hospital change by providing a quantitative estimation of efficiency and effectiveness changes following to the implementation of the PC hospital model. Results show that both efficiency and effectiveness have significantly increased in the average MDC of PC hospitals, thus confirming the need for policy makers to invest in new organizational models close to the principles of PC hospital structures. CONCLUSIONS Although an organizational change towards the PC model can be a costly process, implying a rebalancing of responsibilities and power among hospital personnel (e.g. medical and nursing staff), our results suggest that changing towards a PC model can be worthwhile in terms of both efficacy and efficiency. This evidence can be used to inform and sustain hospital managers and policy makers in their hospital design efforts and to communicate the innovation advantages within the hospital organizations, among the personnel and in the public debate.
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Affiliation(s)
- Carlo V. Fiorio
- Irvapp-FBK, Via Santa Croce 77, Trento, 38122 Italy
- Universitá degli Studi di Milano, Via Conservatorio, 7, Milano, 20121 Italy
- Dondena Centre, Bocconi University, Via Rontgen, 1, Milano, 20136 Italy
| | - Mara Gorli
- Universitá Cattolica del Sacro Cuore, Largo Gemelli, 1, Milano, 20123 Italy
- CERISMAS, Centro di Ricerche e Studi in Management Sanitario c/o Universitá Cattolica del Sacro Cuore, Via Necchi 7, Milano, 20123 Italy
| | - Stefano Verzillo
- European Commission, Joint Research Centre**, Via E. Fermi, 2749, Ispra (VA), 21027 Italy
- CRISP - Interuniversity Research Centre on Public Services, Universitá degli Studi di Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, Milano, 20126 Italy
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Kennedy-Hendricks A, Epstein AJ, Mandell DS, Candon MK, Marcus SC, Xie M, Barry CL. Effects of State Autism Mandate Age Caps on Health Service Use and Spending Among Adolescents. J Am Acad Child Adolesc Psychiatry 2018; 57:125-131. [PMID: 29413145 PMCID: PMC5806145 DOI: 10.1016/j.jaac.2017.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/28/2017] [Accepted: 11/28/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Many states with mandates requiring commercial insurers to cover autism spectrum disorder (ASD) health services specify upper age limits above which coverage is no longer mandated. It is unknown what effects these age caps have on health service use and spending among adolescents who have exceeded the age cap. METHOD Using administrative claims data from 3 national commercial insurers, a difference-in-differences approach was used to estimate effects of age caps on health service use and spending among adolescents with ASD. Statistical models compared changes in use and spending between those above versus below the age cap among individuals eligible versus ineligible for mandated coverage. The analytic sample included data from 2008 through 2012 on 7,845 individuals (151,976 person-months) ages 10 to 21 years in 11 states imposing mandate age caps going into effect during adolescence. RESULTS Age caps were associated with 4.2 percentage point (95% CI = -7.0, -1.5) lower probability of any ASD-specific service use in a month and $69 less (95% CI = -112, -$26) in average monthly spending on ASD-specific services than would have been expected given concomitant pre-post age cap differences among individuals in the same states who were never eligible for mandate-covered services. In addition, age caps were associated with $99 (95% CI = -$168, -$30) lower average monthly spending on all health care services. CONCLUSION Insurance mandates that include age caps going into effect during adolescence reduce health service use and spending among individuals with ASD during a critical phase of the life course.
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Affiliation(s)
| | | | - David S Mandell
- Leonard Davis Institute of Health Economics, Philadelphia; Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Molly K Candon
- Leonard Davis Institute of Health Economics, Philadelphia
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| | - Ming Xie
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Colleen L Barry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Smieliauskas F, Sharma H, Hurley C, de Souza JA, Shih YCT. State insurance mandates and off-label use of chemotherapy. HEALTH ECONOMICS 2018; 27:e55-e70. [PMID: 28726348 DOI: 10.1002/hec.3537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 04/30/2017] [Accepted: 05/15/2017] [Indexed: 06/07/2023]
Abstract
Access to cancer drugs used off-label is important to cancer patients but may drive up healthcare costs with little evidence of clinical benefit. We hypothesized that state health insurance mandates for private insurers to provide coverage for off-label use of cancer drugs cause higher rates of off-label use. We used Truven MarketScan data from 1999 to 2007 on utilization of 35 infused chemotherapy drugs in private health plans in the United States, covering the period when eight states implemented off-label coverage laws. We studied trends in off-label use of drugs, distinguishing between appropriate and inappropriate off-label use according to drug compendia, and estimated difference-in-difference regressions of the effect of state laws on off-label use. We estimate 41% of utilization was off-label, including 17% of use conservatively defined as inappropriate. Trends show gradual declines in off-label use over time. We also find no discernable effect of state laws mandating coverage of off-label use of cancer drugs on utilization patterns under multiple empirical specifications. Our conclusion is that policymakers should consider shifting away from mandating coverage as a way to ensure access to drugs off-label and towards incentivizing adherence to clinical practice guidelines to improve the quality and value of off-label use.
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Affiliation(s)
| | - Hari Sharma
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | | | - Jonas A de Souza
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Ya-Chen Tina Shih
- Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Saloner B, Barry CL. Changes in spending and service use after a state autism insurance mandate. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 23:167-174. [PMID: 29126371 DOI: 10.1177/1362361317728205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Almost all states have insurance coverage mandates for childhood autism spectrum disorder treatment, yet little is known about how mandates affect spending and service use. We evaluated a 2011 Kansas law mandating comprehensive coverage of autism spectrum disorder treatments in the State Employee Health Plan. Data were extracted from the Kansas All-Payer Claims Database from 2009 to 2013 for enrollees of State Employee Health Plan and private health plans. The sample included children aged 0-18 years with >2 claims with an autism spectrum disorder diagnosis insured through State Employee Health Plan or a comparison group enrolled through private health plans. We estimated differences-in-differences regression models to compare trends among State Employee Health Plan to privately insured children. Average annual total spending on autism spectrum disorder services increased by US$912 (95% confidence interval: US$331-US$1492) and average annual out-of-pocket spending on autism spectrum disorder services increased by US$138 (95% confidence interval: US$53-US$223) among diagnosed children in the State Employee Health Plan relative to the comparison group following the mandate, representing 92% and 75% increases over baseline total and out-of-pocket autism spectrum disorder spending, respectively. Average annual quantity of outpatient autism spectrum disorder services increased by 15.0 services (95% confidence interval: 8.4-21.6) among children in the State Employee Health Plan, more than doubling the baseline average. Implementation of a comprehensive autism spectrum disorder mandate in the Kansas State Employee Health Plan was associated with substantial increases in service use and spending for autism spectrum disorder treatment among autism spectrum disorder-diagnosed children.
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22
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Douglas MD, Benevides TW, Carretta H. Analyzing State Autism Private Insurance Mandates for Allied Health Services: A Pilot Study. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017; 37:218-226. [PMID: 28874097 PMCID: PMC5772933 DOI: 10.1177/1539449217730355] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Due to the prevalence, severity, and costs associated with autism spectrum disorders (ASDs), it has become a public health issue. In response, state governments have adopted ASD-specific private insurance mandates requiring coverage of ASD screening, diagnosis, and treatment. Despite rapid uptake of these laws, differences exist in the type and levels of coverage, especially for allied health services including occupational therapy. We piloted a structured legal research methodology to code ASD insurance mandates that impact allied health service provisions. State private insurance mandates were obtained from WestlawNext. A coding methodology was piloted on 14 states and included variables for age and service limits, treatments covered, and medical necessity. Coding methods were feasible and highly reliable among raters. Ten of 12 states had a coverage mandate, many with specific provisions for allied health providers. A full analysis of all 50 states is warranted to identify provisions affecting allied health providers serving individuals with ASD.
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Leslie DL, Iskandarani K, Dick AW, Mandell DS, Yu H, Velott D, Agbese E, Stein BD. The Effects of Medicaid Home and Community-based Services Waivers on Unmet Needs Among Children With Autism Spectrum Disorder. Med Care 2017; 55:57-63. [PMID: 27547947 DOI: 10.1097/mlr.0000000000000621] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several states have passed Medicaid Home and Community-based Services (HCBS) waivers that expand eligibility criteria and available services for children with autism spectrum disorder (ASD). Previous research has shown considerable variation in these waivers, but little is known about the extent to which they address the health care needs of children with ASD. OBJECTIVE To determine the effects of Medicaid HCBS waivers, and their characteristics, on unmet health care needs among children with ASD. METHODS We used data from the 2003, 2007, and 2011 waves of the National Survey of Children's Health with detailed information on the Medicaid HCBS waiver programs of 35 states. Quasi-difference-in-difference-in-differences models were used to determine the effects of waivers and their characteristics on parent report of unmet health care needs of children with ASD compared with children without ASD. RESULTS Greater waiver cost limits per child, estimated costs of services, and enrollment limits were associated with significant decreases in the adjusted rate of unmet health care needs, with considerable variation by household income level. CONCLUSIONS These findings suggest that Medicaid HCBS waivers significantly decrease the unmet need for health care among children with ASD, most substantially among those who would not otherwise qualify for Medicaid. The findings regarding the effects of specific aspects of these waivers can inform the development of insurance policies in other states to address the needs of children with ASD.
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Affiliation(s)
- Douglas L Leslie
- *Penn State College of Medicine, Hershey †RAND Corporation, Pittsburgh ‡Department of Psychiatry and Pediatrics, University of Pennsylvania, Philadelphia, PA
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Stuart EA, McGinty EE, Kalb L, Huskamp HA, Busch SH, Gibson TB, Goldman H, Barry CL. Increased Service Use Among Children With Autism Spectrum Disorder Associated With Mental Health Parity Law. Health Aff (Millwood) 2017; 36:337-345. [PMID: 28167724 PMCID: PMC8320748 DOI: 10.1377/hlthaff.2016.0824] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health care services for children with autism spectrum disorder are often expensive and frequently not covered under private health insurance. The 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was viewed as a possible means of improving access by eliminating differences between behavioral health and medical/surgical benefits. We examined whether the legislation was associated with increased use of and spending on mental health care and functional services for children with autism spectrum disorder compared to the period prior to implementation of the law. We used nationwide health insurance commercial group claims data to examine trends in service use and spending among children with autism spectrum disorder before and after implementation of the law. For such children, implementation was associated with increased use of both mental health and non-mental health services. These increases in use were not associated with higher out-of-pocket spending, which suggests that the law improved financial protection for families.
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Affiliation(s)
- Elizabeth A Stuart
- Elizabeth A. Stuart is associate dean for education, a professor in the Departments of Mental Health, Biostatistics, and Health Policy and Management, and codirector of the Center for Mental Health and Addiction Policy Research, all at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Emma E McGinty
- Emma E. McGinty is an assistant professor in the Departments of Health Policy and Management and Mental Health and Core Faculty of the Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health
| | - Luther Kalb
- Luther Kalb is a doctoral student in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health
| | - Haiden A Huskamp
- Haiden A. Huskamp is a professor of health care policy at Harvard Medical School, in Boston, Massachusetts
| | - Susan H Busch
- Susan H. Busch is a professor of public health and chair of the Department of Health Policy and Management, Yale University School of Public Health, in New Haven, Connecticut
| | - Teresa B Gibson
- Teresa B. Gibson is senior director at Truven Health Analytics in Ann Arbor, Michigan
| | - Howard Goldman
- Howard Goldman is a professor in the Department of Psychiatry, University of Maryland School of Medicine, in Baltimore
| | - Colleen L Barry
- Colleen L. Barry is the Fred and Julie Soper Professor and chair of the Department of Health Policy and Management and codirector of the Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health
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Bilaver LA, Cushing LS, Cutler AT. Prevalence and Correlates of Educational Intervention Utilization Among Children with Autism Spectrum Disorder. J Autism Dev Disord 2016; 46:561-71. [PMID: 26391885 DOI: 10.1007/s10803-015-2598-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study examined the prevalence and correlates of educational intervention utilization among U.S. preschool aged children with autism spectrum disorder (ASD) prior to recent policy changes. The analysis was based on a nationally representative longitudinal survey of children receiving special education services during the 2003-2004 school year. All children with parent or teacher identified ASD over a 3-year study period were analyzed. Outcomes included utilization of speech therapy, occupational therapy, behavior therapy, and mental health services by service sector. The analysis revealed low rates of behavioral therapy and mental health services. Parents reported that the overwhelming majority of services were received inside school only. This study identified gaps in the provision of services for young children with ASD.
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Affiliation(s)
- Lucy A Bilaver
- Department of Public Health, School of Nursing and Health Studies, Northern Illinois University, Wirtz Hall Rm. 253, DeKalb, IL, 60115, USA. .,Chapin Hall at the University of Chicago, 1313 E. 60th St., Chicago, IL, 60637, USA.
| | - Lisa S Cushing
- Department of Special Education, College of Education, University of Illinois-Chicago, 1040 W. Harrison St., M/C 147, Chicago, IL, 60660, USA
| | - Ann T Cutler
- Institute on Disability and Human Development, University of Illinois-Chicago, 1640 W. Roosevelt Rd., M/C 727, Chicago, IL, 60608, USA
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Baller JB, Barry CL, Shea K, Walker MM, Ouellette R, Mandell DS. Assessing early implementation of state autism insurance mandates. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2015; 20:796-807. [PMID: 26614401 DOI: 10.1177/1362361315605972] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the United States, health insurance coverage for autism spectrum disorder treatments has been historically limited. In response, as of 2015, 40 states and Washington, DC, have passed state autism insurance mandates requiring many health plans in the private insurance market to cover autism diagnostic and treatment services. This study examined five states' experiences implementing autism insurance mandates. Semi-structured, key-informant interviews were conducted with 17 participants representing consumer advocacy organizations, provider organizations, and health insurance companies. Overall, participants thought that the mandates substantially affected the delivery of autism services. While access to autism treatment services has increased as a result of implementation of state mandates, states have struggled to keep up with the demand for services. Participants provided specific information about barriers and facilitators to meeting this demand. Understanding of key informants' perceptions about states' experiences implementing autism insurance mandates is useful for other states considering adopting or expanding mandates or other policies to expand access to autism treatment services.
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Affiliation(s)
| | - Colleen L Barry
- Johns Hopkins Bloomberg School of Public Health, USA University of Pennsylvania, USA
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