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Do Insurance Mandates Affect Racial Disparities in Outcomes for Children with Autism?

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A Correction to this article was published on 07 February 2019

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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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Change history

  • 07 February 2019

    The original version of this article unfortunately contained a mistake in the analysis of the Tables?4 and 5.

  • 07 February 2019

    The original version of this article unfortunately contained a mistake in the analysis of the Tables��4 and 5.

References

  • Anderson, M., Dobkin, C., Gross, T. (2012). The effect of health insurance coverage on the use of medical services. American Economic Journal, 4(1), 1–27.

    Google Scholar 

  • Barry, C. L., & Busch, S. H. (2007). Do state parity laws reduce the financial burden on families of children with mental health care needs? Health Services Research, 42(3 Pt 1), 1061–1084.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bilaver, L. A., & Jordan, N. (2013). Impact of state mental health parity laws on access to autism services. Psychiatric Services, 64(10), 967–973.

    Article  PubMed  Google Scholar 

  • Blumberg, S. J., Bramlett, M. D., Kogan, M. D., Schieve, L. A., Jones, J. R., Lu, M. C. (2013). Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007 to 2011–2012. National health statistics reports, Vol. 65. Hyattsville, MD: National Center for Health Statistics.

  • Blumberg, S. J., Welch, E. M., Chowdhury, S. R., Upchurch, H. L., Parker, E. K., & Skalland, B. J. (2008). Design and operation of the Naltional Survey of children with special health care needs, 2005–2006. Vital Health Statistics, 45(1), 1–188.

    Google Scholar 

  • Buchmueller, T. C., Cooper, P. F., Jacobson, M., & Zuvekas, S. H. (2007). Parity for whom? Exemptions and the extent of state mental health parity legislation. Health Affairs, 26(4), w483–w487.

    Article  PubMed  Google Scholar 

  • Candon, M. K., & Bradford, D. W. (2014). Mis-detection controlled estimation: Explaining variations in the observed incidence of autism. Social Science Research Network. doi:10.2139/ssrn.2519117.

    Google Scholar 

  • Chasson, G. S., Harris, G. E., & Neely, W. J. (2007). Cost comparison of early intensive behavioral intervention and special education for children with autism. Journal of Child and Family Studies, 16(3), 401–413.

    Article  Google Scholar 

  • Chatterji, P., Decker, S. L., & Markowitz, S. (2015). The effects of mandated health insurance benefits for autism on out-of-pocket costs and access to treatment. Journal of Policy Analysis and Management. doi:10.1002/pam.21814.

    PubMed  Google Scholar 

  • Currie, J., Decker, S., & Lin, W. (2008). Has public health insurance for older children reduced disparities in access to care and health outcomes? Journal of health Economics, 27(6), 1567–1581.

    Article  PubMed  Google Scholar 

  • Flores, G., & The Committee on Pediatric Research. (2010). Racial and ethnic disparities in the health and health care of children. Pediatrics, 125(4), e979–e1020.

    Article  PubMed  Google Scholar 

  • Gruber, J., & Poterba, J. (1994). Tax incentives and the decision to purchase health insurance: Evidence from the self-employed. The Quarterly Journal of Economics, 109(3), 701–733.

    Article  Google Scholar 

  • Jarquin, V. G., Wiggins, L. D., Schieve, L. A., & Van Naarden-Braun, K. (2011). Racial disparities in community identification of autism spectrum disorders over time; Metropolitan Atlanta, Georgia, 2000–2006. Journal of Developmental and Behavioral Pediatrics, 32(3), 179–187.

    Article  PubMed  Google Scholar 

  • Johnson, R. A., Danis, M., Hafner-Eaton, C. (2014). US state variation in autism insurance mandates: Balancing access and fairness. Autism, 18(7), 803–814.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kuhlthau, K., Payakachat, N., Delahaye, J., Hurson, J., Pyne, J. M., Kovacs, E., et al. (2014). Quality of life for parents of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 8(10), 1339–1350.

    Article  Google Scholar 

  • L&M Policy Research L. (2014). Autism spectrum disorders (ASD): State of the states of services and supports for people with ASD. HHSM-500-2006-00009I/HHSM-500-T0002. Washington DC, District of Columbia.

  • Lord, C., & Bishop, S. L. (2010). Social policy report; Autism spectrum disorders diagnosis, prevalence, and services for children and families. Sharing Child Youth Development Knowledge, 24(2), 1–27.

    Google Scholar 

  • Magana, S., Parish, S. L., Rose, R. A., Timberlake, M., & Swaine, J. G. (2012). Racial and ethnic disparities in quality of health care among children with autism and other developmental disabilities. Intellectual and developmental disabilities, 50(4), 287–299.

    Article  PubMed  Google Scholar 

  • Mahmoudi, E., & Jensen, G. A. (2014). Has medicare part D reduced racial/ethnic disparities in prescription drug use and spending? Health Services Research, 49(2), 502–525.

    Article  PubMed  Google Scholar 

  • Mandell, D. S., Wiggins, L. D., Carpenter, L. A., Daniels, J., DiGuiseppi, C., Durkin, M. S., et al. (2009). Racial/ethnic disparities in the identification of children with autism spectrum disorders. American Journal of Public Health, 99(3), 493–498.

    Article  PubMed  PubMed Central  Google Scholar 

  • Medical Home Initiatives for Children With Special Needs Project advisory committee. (2002). The Medical Home. Pediatrics, 110(1), 184–186.

    Article  Google Scholar 

  • Montes, G., & Halterman, J. S. (2011). White–black disparities in family-centered care among children with autism in the United States: Evidence From the NS-CSHCN 2005ΓÇô2006. Academic Pediatrics, 11(4), 297–304.

    Article  PubMed  Google Scholar 

  • Myers, S. M., Johnson, C. P., & The Council on Children with Disabilities. (2007). Management of Children With Autism Spectrum Disorders. Pediatrics, 120(5), 1162–1182.

    Article  PubMed  Google Scholar 

  • National Conference of State Legislature (2013). Autism and insurance coverage State laws. http://www.ncsl.org/research/health/autism-and-insurance-coverage-state-laws.aspx.

  • Parish, S., Magana, S., Rose, R., Timberlake, M., & Swaine, J. G. (2012). Health care of latino children with autism and other developmental disabilities: Quality of provider interaction mediates utilization. American Journal on Intellectual and Developmental Disabilities, 117(4), 304–315.

    Article  PubMed  Google Scholar 

  • Peele, P. B., Lave, J. R., & Kelleher, K. J. (2002). Exclusions and limitations in children’s behavioral health care coverage. Psychiatric Services, 53(5), 591–594.

    Article  PubMed  Google Scholar 

  • Sharpe, D., & Baker, D. (2007). Financial issues associated with having a child with autism. Journal of Family and Economic Issues, 28(2), 247–264.

    Article  Google Scholar 

  • Stein, B. D., Sorbero, M. J., Goswami, U., Schuster, J., & Leslie, D. L. (2012). Impact of a private health insurance mandate on public sector autism service use in Pennsylvania. Journal of the American Academy of Child and Adolescent Psychiatry, 51(8), 771–779.

    Article  PubMed  Google Scholar 

  • Tai-Seale, M., Freund, D., & LoSasso, A. (2001). Racial disparities in service use among medicaid beneficiaries after mandatory enrollment in managed care: A difference-in-differences approach. Inquiry, 38(1), 49–59.

    CAS  PubMed  Google Scholar 

  • Taylor, J. L., Dove, D., Veenstra-Vanderweele, J., Sathe, N. A., McPheeters, M. L., Jerome, R. N., et al. (2012). Interventions for adolescents and young adults with autism spectrum disorders. Comparative effectiveness reviews 65. Rockville, MD: Agency for Healthcare Research and Quality.

    Google Scholar 

  • The Interagency Autism Coordinating Committee (2011). IACC strategic plan for autism spectrum disorder research. Department of Health and Human Services—Interagency Autism Coordinating Committee website.

  • Thomas, K. C., Ellis, A. R., McLaurin, C., Daniels, J., & Morrissey, J. P. (2007). Access to care for autism-related services. Journal of Autism and Developmental Disorders, 37(10), 1902–1912.

    Article  PubMed  Google Scholar 

  • United States Department of Labor. Self-insured health benefit plans (2013). http://www.dol.gov/ebsa/pdf/ACASelfFundedHealthPlansReport033113.pdf, editors.

  • Weitlauf, A. S., McPheeters, M. L., Peters B., Sathe, N., Travis, R., Aiello, R., et al. (2014). Therapies for children with autism spectrum disorder: Behavioral intervention update. 137, 103–104. Rockville, MD: Agency for Healthcare Research and Quality. Comparative Effectiveness Review.

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Authors and Affiliations

  1. University of Kentucky, Lexington, KY, USA

    Pratik Doshi

  2. Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    J. Mick Tilford

  3. Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Songthip Ounpraseuth

  4. Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Dennis Z. Kuo

  5. Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 W. Markham St, 522, Little Rock, AR, USA

    Nalin Payakachat

Authors
  1. Pratik Doshi
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  2. J. Mick Tilford
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  3. Songthip Ounpraseuth
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  4. Dennis Z. Kuo
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  5. Nalin Payakachat
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Corresponding author

Correspondence to Nalin Payakachat.

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Appendices

Appendix 1

See Table 5.

Appendix 2

See Fig. 1.

Fig. 1
figure 1

Derivation of study population of children with autism spectrum disorders (ASDs) in 2005/06 and 2009/10 the National Survey of Children with Special Health Care Needs. aExcluded children from CA, GA, IN, and MD

Full size image

Appendix 3

Unadjusted marginal effects were determined using the equation: Y = β 0  + β1X w  + β2X r  + β3X i,p1  + β4X * i,p1 X w  + β *5 X * i,p1 X r  + β *6 X * w X r  + β *7 X * w X r *X i,p1  + ε, where Y is the outcome of interest; β 0 is the intercept; X w is the wave indicator; X r is race indicator variable; X p1 is the private insurance mandate indicator variable with respect to a state i in each wave, where a state in the control group is the reference category; β7 is the DDD estimate. The statistical significance of β7 was used to assess the significance of the policy impact on racial disparities for the given outcome.

For adjusted marginal effects, the following equation was applied: Y = β0 + β1Xw + β2Xr + β3Xi,p1 + β4Xi,p1*Xw + β5*Xi,p1*Xr + β6*Xw*Xr + β7*Xw*Xr *Xi,p1 + γXicf + ε, where Xicf is a vector of covariates for child demographics (age, gender, type of insurance), family characteristics (education level, family poverty levels), and child clinical variables (i.e., the number of psychiatric and physical comorbidities). Other variables are the same as in the unadjusted analyses.

Appendix 4

See Tables 6, 7, 8, 9 and 10.

Appendix 5

Survey weight generation for the 2005/06 wave of the data: http://www.cdc.gov/nchs/data/series/sr_01/sr01_045.pdf.

Survey weight generation for the 2009/10 wave of the date: http://www.cdc.gov/nchs/data/series/sr_01/sr01_057.pdf.

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Doshi, P., Tilford, J.M., Ounpraseuth, S. et al. Do Insurance Mandates Affect Racial Disparities in Outcomes for Children with Autism?. Matern Child Health J 21, 351–366 (2017). https://doi.org/10.1007/s10995-016-2120-z

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