Colleen L Barry1,2,3, Alene Kennedy-Hendricks4,2, David Mandell3,5, Andrew J Epstein6, Molly Candon3,5, Matthew Eisenberg4,2. 1. Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland; cbarry@jhu.edu. 2. Johns Hopkins Center for Mental Health and Addiction Policy Research, Baltimore, Maryland. 3. Leonard Davis Institute of Health Economics and. 4. Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland. 5. Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and. 6. Medicus Economics, Milton, Massachusetts.
Abstract
OBJECTIVES: Most states have passed insurance mandates requiring health plans to cover services for children with autism spectrum disorder (ASD). Research reveals that these mandates increased treated prevalence, service use, and spending on ASD-related care. As employer-sponsored insurance shifts toward high-deductible health plans (HDHPs), it is important to understand how mandates affect children with ASD in HDHPs relative to traditional, low-deductible plans. METHODS: Insurance claims for 2008-2012 for children covered by 3 large US insurers (United Healthcare, Aetna, and Humana) available through the Health Care Cost Institute were used to compare the effects of mandates on ASD-related spending for children in HDHPs and traditional health plans. RESULTS: Relative to children in traditional plans, mandates were associated with higher average monthly spending increases for children in HDHPs. Mandate-attributable spending differences between children enrolled in HDHPs relative to traditional plans were $77 for ASD-specific services (95% confidence interval [CI]: $10 to $144), $125 for outpatient health services (95% CI: $26 to $223), and $144 for all health services (95% CI: $36 to $253). These spending differentials were driven by differences in plan spending and not out-of-pocket (OOP) spending. CONCLUSIONS: Spending on ASD-related services attributable to autism mandates was higher among children in HDHPs, but higher spending did not translate into a greater OOP burden. For families with consistently high health care expenditures on ASD-related services, high-deductible products may be worth considering in the context of mandate laws. Families in mandate states with children with ASD enrolled in HDHPs were able to increase service use without paying more OOP.
OBJECTIVES: Most states have passed insurance mandates requiring health plans to cover services for children with autism spectrum disorder (ASD). Research reveals that these mandates increased treated prevalence, service use, and spending on ASD-related care. As employer-sponsored insurance shifts toward high-deductible health plans (HDHPs), it is important to understand how mandates affect children with ASD in HDHPs relative to traditional, low-deductible plans. METHODS: Insurance claims for 2008-2012 for children covered by 3 large US insurers (United Healthcare, Aetna, and Humana) available through the Health Care Cost Institute were used to compare the effects of mandates on ASD-related spending for children in HDHPs and traditional health plans. RESULTS: Relative to children in traditional plans, mandates were associated with higher average monthly spending increases for children in HDHPs. Mandate-attributable spending differences between children enrolled in HDHPs relative to traditional plans were $77 for ASD-specific services (95% confidence interval [CI]: $10 to $144), $125 for outpatient health services (95% CI: $26 to $223), and $144 for all health services (95% CI: $36 to $253). These spending differentials were driven by differences in plan spending and not out-of-pocket (OOP) spending. CONCLUSIONS: Spending on ASD-related services attributable to autism mandates was higher among children in HDHPs, but higher spending did not translate into a greater OOP burden. For families with consistently high health care expenditures on ASD-related services, high-deductible products may be worth considering in the context of mandate laws. Families in mandate states with children with ASD enrolled in HDHPs were able to increase service use without paying more OOP.
Authors: Jessica Greene; Judith Hibbard; James F Murray; Steven M Teutsch; Marc L Berger Journal: Health Aff (Millwood) Date: 2008 Jul-Aug Impact factor: 6.301
Authors: J Frank Wharam; Fang Zhang; Emma M Eggleston; Christine Y Lu; Stephen Soumerai; Dennis Ross-Degnan Journal: JAMA Intern Med Date: 2017-03-01 Impact factor: 21.873
Authors: Alison A Galbraith; Stephen B Soumerai; Dennis Ross-Degnan; Meredith B Rosenthal; Charlene Gay; Tracy A Lieu Journal: J Gen Intern Med Date: 2012-01-18 Impact factor: 5.128
Authors: Colleen L Barry; Andrew J Epstein; Steven C Marcus; Alene Kennedy-Hendricks; Molly K Candon; Ming Xie; David S Mandell Journal: Health Aff (Millwood) Date: 2017-10-01 Impact factor: 6.301
Authors: Scott D Grosse; Phyllis Nichols; Kwame Nyarko; Matthew Maenner; Melissa L Danielson; Lindsay Shea Journal: J Autism Dev Disord Date: 2021-09-28
Authors: Nkengafac Villyen Motaze; Primus Che Chi; Pierre Ongolo-Zogo; Jean Serge Ndongo; Charles S Wiysonge Journal: Cochrane Database Syst Rev Date: 2021-02-22