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Medicaid Expenditures for Children with Autistic Spectrum Disorders: 1994 to 1999

  • David S. MandellEmail author
  • Jun Cao
  • Richard Ittenbach
  • Jennifer Pinto-Martin
Article

Abstract

This study used data from 1994 to 1999 from one large county in Pennsylvania to estimate the Medicaid expenditures of children diagnosed with autism spectrum disorders (ASD) and to compare these expenditures with those of other Medicaid-eligible children. On average, children diagnosed with ASD had expenditures 10 times those of other children. Differences in expenditures were driven in large part by inpatient psychiatric care. Further research is required to determine whether hospitalized children could be served in less restrictive and less expensive settings. Lack of differences in ambulatory care expenditures suggests that children with ASD are not receiving additional primary care services that would be indicative of appropriately coordinated services as suggested by the medical home model.

Keywords

Autism medicaid healthcare costs 

Notes

Acknowledgments

This study was funded by a Mentored Scientist Career Development Award (K01) from the National Institute of Mental Health (1 K01 MH067628).

References

  1. Aman M., Lam K., Collier-Crespin A., (2003). Prevalence and patterns of use of psychoactive medicines among individuals with autism in the Autism Society of America Journal of Autism and Developmental Disorders 33(5): 527–533CrossRefPubMedGoogle Scholar
  2. Aman M., Langworthy K., (2000). Pharmacotherapy for hyperactivity in children with autism and other pervasive developmental disorders Journal of Autism and Developmental Disorders 30(5): 451–459CrossRefPubMedGoogle Scholar
  3. American Academy of Pediatrics (2001). The pediatrician’s role in the diagnosis and management of autistic spectrum disorder in children Pediatrics 107(5): 1221–1226CrossRefGoogle Scholar
  4. Barnard L., Young A., Pearson J., Geddes J., O’Brien G., (2002). A systematic review of the use of atypical antipsychotics in autism Journal of Psychopharmacology 16(1):93–101PubMedCrossRefGoogle Scholar
  5. Birenbaum A., Guyot D., Cohen H., (1990). Health care financing for severe developmental disabilities Monographs of the American Association on Mental Retardation 14:1–150PubMedGoogle Scholar
  6. Bonde E., (2000). Comorbidity and subgroups in childhood autism European Child and Adolescent Psychiatry 9:7–10CrossRefPubMedGoogle Scholar
  7. Boyle C., Decoufle P., Yeargin-Allsopp M., (1994). Prevalence and health impact of developmental disabilities in US children Pediatrics 93:399–403PubMedGoogle Scholar
  8. Braddock D., (2002). Disability at the dawn of the 21st century and the state of states. American Association on Mental Retardation, Washington, DCGoogle Scholar
  9. Bryson S., Rogers S., Fombonne E., (2003). Autism spectrum disorders: Early detection, intervention, education, and psychopharmacological management Canadian Journal of Psychiatry 48(8):506–516Google Scholar
  10. Bryson S., Smith I., (1998). Epidemiology of autism: Prevalence, associated characteristics, and implications for research and service delivery Mental Retardation and Developmental Disabilities Research Reviews 4:97–103CrossRefGoogle Scholar
  11. Committee on Children with Disabilities (2001). American Academy of Pediatrics: The pediatrician’s role in the diagnosis and management of autistic spectrum disorder in children. Pediatrics. 107(5): 1221–1226CrossRefGoogle Scholar
  12. Committee on Children with Disabilities (2001a). Role of the pediatrician in family-centered early intervention services Pediatrics 107(5):1155–1157CrossRefGoogle Scholar
  13. Committee on Children with Disabilities (2001b). Technical report: The pediatrician’s role in the diagnosis and management of autistic spectrum disorder in children Pediatrics 107(5):E85CrossRefGoogle Scholar
  14. Couris C. M., Rabilloud M., Colin C., Ecochard R., (2002). Two-phase study to assess the number of cases based on claims databases: Characteristics of the validation data set Methods of Information in Medicine 41(4):349–356PubMedGoogle Scholar
  15. Dresser M. V. B., Feingold L., Rosenkranz S. L., Coltin K. L., (1997). Clinical quality measurement—Comparing chart review and automated methodologies Medical Care 35(6):539–552CrossRefPubMedGoogle Scholar
  16. Eisenmajer R., Prior M., Leekam S., Wing L., Gould J., Welham M., Ong B., (1996). Comparison of clinical symptoms in autism and Asperger’s disorder Journal of the American Academy of Child and Adolescent Psychiatry 35(11):1523–1531CrossRefPubMedGoogle Scholar
  17. Fombonne E., (2003). Epidemiological surveys of autism and other pervasive developmental disorders: An update Journal of Autism and Developmental Disorders 33(4):365–382PubMedCrossRefGoogle Scholar
  18. Fujiura G. T., Roccoforte J. A., Braddock D., (1994). Costs of family care for adults with mental retardation and related developmental disabilities American Journal on Mental Retardation 99(3):250–261PubMedGoogle Scholar
  19. Gallaher M., Christakis D., Connell F., (2002). Health care use by children diagnosed as having developmental delay Archives of Pediatrics and Adolescent Medicine 156(3):246–251PubMedGoogle Scholar
  20. Gerlai J., Gerlai R., (2003). Autism: A large unmet medical need and a complex research problem Physiology and Behavior 79:461–470CrossRefPubMedGoogle Scholar
  21. Guevara J., Mandell D., Rostain A., Zhao H., Hadley T., (2003). National estimates of health services expenditures for children with behavioral disorders: An analysis of the medical expenditure panel survey Pediatrics 112(6):e440–e446CrossRefPubMedGoogle Scholar
  22. Hill A., Bolte S., Petrova G., Beltcheva D., Tacheva S., Poustka F., (2001). Stability and interpersonal agreement of the interview-based diagnosis of autism Psychopathology 34(4): 187–191CrossRefPubMedGoogle Scholar
  23. Hughes J., Grayson R., Stiles F., (1977). Fragmentation of care and the medical home Pediatrics 60(4):559PubMedGoogle Scholar
  24. Ireys H., Anderson G., Han C., Neff J., (1996). Cost of care for Medicaid-enrolled children with selected disabilities. US Department of Health and Human Services, Washington, DCGoogle Scholar
  25. Jacobson J., Mulick J., (2000). System and cost research issues in treatments for people with autistic disorders Journal of Autism & Developmental Disorders 30(6):585–593CrossRefGoogle Scholar
  26. Jacobson J., Mulick J., Green G., (1998). Cost-Benefit Estimates for Early Intensive Behavioral Intervention for Young Children With Autism- General Model and Single State Case Behavioral Interventions 13:201–226CrossRefGoogle Scholar
  27. Jarbrink K., Fombonne E., Knapp M., (2003). Measuring the Parental, Service and Cost Impacts of Children with Autistic Spectrum Disorder: A Pilot Study Journal of Autism & Developmental Disorders 33(4):395–402CrossRefGoogle Scholar
  28. Jarbrink K., Knapp M., (2001). The economic impact of autism in Britain Autism 5(1):7–22CrossRefPubMedGoogle Scholar
  29. Jerrell J.. (1998). Utilization management analysis for children’s mental health services Journal of Behavioral Health Services & Research 25(1):35–42CrossRefGoogle Scholar
  30. Kashner T.M., (1998). Agreement between administrative files and written medical records-A case of the department of veterans affairs Medical Care 36(9):1324–1336CrossRefPubMedGoogle Scholar
  31. Klabunde C.N., Potosky A.L., Legler J.M., Warren J.L., (2000). Development of a comorbidity index using physician claims data Journal of Clinical Epidemiology 53(12):1258–1267CrossRefPubMedGoogle Scholar
  32. Krauss M., Gulley S., Sciegaj M., Wells N., (2003). Access to specialty medical care for children wtih mental retardation, autism and other special health care needs Mental Retardation 41(5):329–339PubMedCrossRefGoogle Scholar
  33. Lurie N., Popkin M., Dysken M., Moscovice I., Finch M., (1992). Accuracy of diagnoses of schizophrenia in Medicaid claims Hospital & Community Psychiatry 43:69–71Google Scholar
  34. Mahoney W., Szatmari P., MacLean J., Bryson S., Bartolucci G., Walter S., Jones M., Zwaigenbaum L., (1998). Reliability and accuracy of differentiating pervasive developmental disorder subtypes Journal of the American Academy of Child & Adolescent Psychiatry 37(3):278–285CrossRefGoogle Scholar
  35. Mandell D., Listerud J., Levy S., Pinto-Martin J., (2002). Race Differences in the Age of Diagnosis among Medicaid-Eligible Children with Autism Journal of the American Academy of Child & Adolescent Psychiatry 41(12):1447–1453CrossRefGoogle Scholar
  36. Marcus L., Rubin J., Rubin M., (2000). Benefit-cost analysis and autism services: a response to Jacobson and Mulick Journal of Autism and Developmental Disorders 30:595–598CrossRefPubMedGoogle Scholar
  37. Matson J., Benavidez D., Compton L., Paclawskyj T., Baglio C., (1996). Behavioral treatment of autistic persons: A review of research from 1980 to the present Research in Developmental Disabilities 17(6):433–465CrossRefPubMedGoogle Scholar
  38. Medicode. (1987). International classification of diseases, 9 Med-Index Publications, Salt Lake City, UTGoogle Scholar
  39. Newschaffer C., Curran L., (2003). Autism: An emerging public health problem Public Health Reports 118(5):393–399PubMedGoogle Scholar
  40. Rawson N. S. B., D’Arcy C., (1998). Assessing the validity of diagnostic information in administrative health care utilization data: Experience in Saskatchewan Pharmacoepidemiology and Drug Safety 7(6):389–398CrossRefPubMedGoogle Scholar
  41. Rawson N. S. B., Malcolm E., (1995). Validity of the recording of ischaemic heart disease and chronic obstructive pulmonary disease in the Saskatchewan health care datafiles Statistics in Medicine 14(24):2627–2643PubMedCrossRefGoogle Scholar
  42. Richdale A., (1999). Sleep problems in autism: Prevalence, cause, and intervention Developmental Medicine and Child Neurology 41(1):60–66CrossRefPubMedGoogle Scholar
  43. Rinehart N., Bradshaw J., Brereton A., Tonge B., (2002). A clinical and neurobehavioural review of high-functioning autism and Asperger’s disorder Australian and New Zealand Journal of Psychiatry 36(6):762–770CrossRefPubMedGoogle Scholar
  44. Romano P. S., (2000). Using administrative data to identify associations between implanted medical devices and chronic diseases Annals of Epidemiology 10(4):197–199CrossRefPubMedGoogle Scholar
  45. Ryu S. Y., Park J. K., Suh I., Jee S. H., Park J., Kim C. B., Kim K. S., (2000). The accuracy of myocardial infarction diagnosis in medical insurance claims Yonsei Medical Journal 41(5):570–576PubMedGoogle Scholar
  46. SAS Version 8.0 (2000). Cary, NC: The SAS InstituteGoogle Scholar
  47. Shatin D., Levin R., Ireys H., Haller V., (1998). Health care utilization by children with chronic illnesses: A comparison of Medicaid and employer-insured managed care Pediatrics 102(4):1–9CrossRefPubMedGoogle Scholar
  48. Shatin D., Schech S. D., Patel K., McHutchison J. G., (2004). Population-based hepatitis C surveillance and treatment in a national managed care organization American Journal of Managed Care 10(4):250–256PubMedGoogle Scholar
  49. Sia C., (1992). Abraham Jacobi Award address, April 14, 1992 the medical home: Pediatric practice and child advocacy in the 1990s Pediatrics 90(3):419–423PubMedGoogle Scholar
  50. Sia, C., & Breakey, G. (1985). The role of the medical home in child abuse prevention and positive child development. Hawaii Medical Journal, 44(7), 242–244, 247Google Scholar
  51. Stein R., Silver E., (2003). Patterns of medical, educational and mental health service use in a national sample of US children Ambulatory Pediatrics 3(2):87–92CrossRefPubMedGoogle Scholar
  52. US Department of Education (2003). Twenty-fifth annual report to congress on the implementation of the Individuals with Disabilities Education Act. Bureau of Special Education, Jessup, MDGoogle Scholar
  53. Volkmar F., Pauls D., (2003). Autism Lancet 362(9390):1133–1141CrossRefPubMedGoogle Scholar
  54. Walkup J. T., Boyer C. A., Kellermann S. L., (2000). Reliability of medicaid claims files for use in psychiatric diagnoses and service delivery Administration and Policy in Mental Health 27(3):129–139CrossRefPubMedGoogle Scholar
  55. Walsh K., Kastner T., Criscione T., (1997). Characteristics of hospitalizations for people with developmental disabilities: Utilization, costs, and impact of care coordination American Journal of Mental Retardation 101(5):505–520PubMedGoogle Scholar
  56. Woods C. R., (2001). Impact of different definitions on estimates of accuracy of the diagnosis data in a clinical database Journal of Clinical Epidemiology 54(8):782–788CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • David S. Mandell
    • 1
    • 2
    • 6
    Email author
  • Jun Cao
    • 3
  • Richard Ittenbach
    • 4
  • Jennifer Pinto-Martin
    • 5
  1. 1.Department of PsychiatryUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  2. 2.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of StatisticsTemple UniversityPhiladelphiaUSA
  4. 4.Division of BiostatisticsThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  5. 5.University of Pennsylvania School of NursingPhiladelphiaUSA
  6. 6.Department of Psychiatry, Center for Mental Health Policy & Services ResearchUniversity of Pennsylvania Health SystemPhiladelphiaUSA

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