Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder

Barry, Colleen L.; Epstein, Andrew J.; Marcus, Steven C.; Kennedy-Hendricks, Alene; Candon, Molly; Xie, Ming; Mandell, David S.

doi:10.1377/hlthaff.2017.0515

Cited by 37 publications

(39 citation statements)

References 30 publications

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“…Certainly, this underscores the need for a thorough but simple and clearly worded consent form that ensures potential participants are not conflating care and clinical research; however, the possibility of even a subtle coercion is worrisome. In addition to the need for more comprehensive state insurance mandates for ASD-related services (which has been shown to improve access to care [54]), there may be more immediate implications for ethical oversight in studies that provide services to participants, especially for families of youth with mental health conditions who may be particularly in need of those services.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Participation in Biospecimen Research among Parents of Youth with Mental Health Conditions

Owen-Smith

Sesay

Lynch

et al. 2020

Public Health Genomics

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Introduction: Biospecimens are tools that have the potential to improve early identification and treatment for autism spectrum disorders (ASD) and bipolar disorders (BPD). Unfortunately, most biobanks lack racial/ethnic diversity. One challenge to including a diverse sample of youth is recruiting and engaging families. Objective: We sought to better understand facilitators and barriers to participation in biospecimen research among a diverse group of parents of youth with ASD and BPD. Methods: The current study involved 3 Mental Health Research Network sites. At each site, parents participated in an interview that explored attitudes and beliefs about genetic research. Interviews were audio-recorded, and audio files were transcribed and coded using content analysis. Results: A total of 58 interviews were conducted. Four challenges emerged: (1) contacting and engaging potential research participants, (2) motivating potential participants to read recruitment and consent materials, (3) motivating participation in research, in general, and (4) motivating participation in research involving biospecimen donation, specifically. Conclusions: Participants were eager to participate as long as the research process involved trust, clarity, and flexibility. Future research involving youth with mental health conditions would benefit from implementing multimodal strategies for recruitment and data collection and sharing knowledge gained by the research with study participants.

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Section: Discussionmentioning

confidence: 99%

Factors Influencing Participation in Biospecimen Research among Parents of Youth with Mental Health Conditions

Owen-Smith

Sesay

Lynch

et al. 2020

Public Health Genomics

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“…19,20 One reason for the opposite findings may be that mandates that target children with ASD resulted in a much larger change in service use than mental health parity legislation. 10,19 Thus, even if the insurer shoulders the majority of the newfound costs, families can end up spending more out of pocket when increases in service use are substantial.…”

Section: Discussionmentioning

confidence: 99%

“…The authors of 2 recent studies found that mandates led to an increase in both the number of children in treatment with a diagnosis of ASD and the use of and spending on ASD-related services; they also found that the magnitude of these effects grew over time. 8,10 These results are promising, but increases in service use due to the passage of mandates may inadvertently result in higher out-ofpocket spending among families of children with ASD, especially if the child's ASD is severe or the family has a health plan with high cost-sharing requirements. Although insurance coverage has generally been shown to reduce financial burdens faced by patients, 11,12 the change in out-ofpocket spending after an expansion of coverage ultimately depends on the extent to which patients respond to increased coverage with increased service use.…”

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confidence: 99%

Insurance Mandates and Out-of-Pocket Spending for Children With Autism Spectrum Disorder

et al. 2019

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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 ASDspecific 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. abstract NIH

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“…22 The exposure of interest (mandate) was included with a one-year lag to allow a sufficient time interval after law ratification for the mandate to have an effect on observed outcomes. 7 We limited our analysis to this one-year interval to minimize the potential for other policies or factors to influence measured effects. We also included the time-varying covariates as described above.…”

Section: State Mandates and Workforce Supplymentioning

confidence: 99%

“…In one recent study, the authors found that the probability of using ASDspecific pediatric services in a month was 27.9% in states with mandates versus 25.0% in nonmandate states. 7 Others have observed that monthly family spending on autism-related child health care services has increased by ,$100 as a function of mandates. [7][8][9][10] One potential explanation for these limited impacts is that mandates primarily remove financial barriers to accessing care but do not directly address a shortage in service availability: more than half of US counties have no board-certified behavioral analysts (BCBAs) who provide therapy to help children with ASD improve social and communication skills.…”

mentioning

confidence: 99%

State Insurance Mandates and the Workforce for Children With Autism

et al. 2020

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BACKGROUND: State mandates have required insurance companies to provide coverage for autismrelated child health care services; however, it has not been determined if insurance mandates have improved the supply of child health care providers. We investigate the effect of state insurance mandates on the supply of child psychiatrists, pediatricians, and board-certified behavioral analysts (BCBAs). METHODS: We used data from the National Conference of State Legislatures and Health Resources and Services Administration's Area Health Resource Files to examine child psychiatrists, pediatricians, and BCBAs in all 50 states from 2003 to 2017. Fixed-effects regression models compared change in workforce density before versus one year after mandate implementation and the effect of mandate generosity across 44 US states implementing mandates between 2003 and 2017. RESULTS: From 2003 to 2017, child psychiatrists increased from 7.40 to 10.03 per 100 000 children, pediatricians from 62.35 to 68.86, and BCBAs from 1.34 to 29.88. Mandate introduction was associated with an additional increase of 0.77 BCBAs per 100 000 children (95% confidence interval [CI]: 0.18 to 1.42) one year after mandate enactment. Mandate introduction was also associated with a more modest increase among child psychiatrists (95% CI: 0.10 to 0.91) and was not associated with the prevalence of pediatricians (95% CI: 20.76 to 1.13). We also found evidence that more generous mandate benefits were associated with larger effects on workforce supply. CONCLUSIONS: State insurance mandates were associated with an ∼16% increase in BCBAs from 2003 to 2017, but the association with child psychiatrists was smaller and nonsignificant among pediatricians. In these findings, it is suggested that policies are needed that specifically address workforce constraints in the provision of services for children with autism spectrum disorder.

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Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder

Cited by 37 publications

References 30 publications

Factors Influencing Participation in Biospecimen Research among Parents of Youth with Mental Health Conditions

Factors Influencing Participation in Biospecimen Research among Parents of Youth with Mental Health Conditions

Insurance Mandates and Out-of-Pocket Spending for Children With Autism Spectrum Disorder

State Insurance Mandates and the Workforce for Children With Autism

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