Healthcare Service Use and Costs for Autism Spectrum Disorder: A Comparison Between Medicaid and Private Insurance
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Healthcare costs and service use for autism spectrum disorder (ASD) were compared between Medicaid and private insurance, using 2003 insurance claims data in 24 states. In terms of costs and service use per child with ASD, Medicaid had higher total healthcare costs ($22,653 vs. $5,254), higher ASD-specific costs ($7,438 vs. $928), higher psychotropic medication costs($1,468 vs. $875), more speech therapy visits (13.0 vs. 3.6 visits), more occupational/physical therapy visits (6.4 vs. 0.9 visits), and more behavior modification/social skills visits (3.8 vs. 1.1 visits) than private insurance (all p < 0.0001). In multivariate analysis, being enrolled in Medicaid had the largest effect on costs, after controlling for other variables. The findings emphasize the need for continued efforts to improve private insurance coverage of autism.
KeywordsAutism spectrum disorder Children Healthcare costs Service use Medicaid Private insurance
This study is funded by the National Institute of Mental Health through an R01 awarded to Dr. Leslie.
- AutismSpeaks (2012). Autism speaks state autism insurance reform initiatives. Available at http://www.autismvotes.org/site/c.frKNI3PCImE/b.3909861/k.B9DF/State_Initiatives.htm.
- CDC (Centers for Disease Control and Prevention). (2012). Centers for Disease Control and Prevention: Autism Spectrum Disorders. Available at http://www.cdc.gov/ncbddd/autism/index.html.
- CMHPSR (Center for Mental Health Policy and Services Research) at the Univeristy of Pennsylvania, (2012). Tools for researchers: Procedure code categories. Available at http://www.med.upenn.edu/cmhpsr/resources.html.
- DHHS (Department of Health and Human Services). (2009). Medicaid managed care encounter data: Collection and use. Available at http://oig.hhs.gov/oei/reports/oei-07-06-00540.pdf.
- Miles, J. H., McCathren, R. B., Stichter, J., Shinawi, M. (2010) Autism spectrum disorders. In R. A. Pagon, T. D. Bird, C. R. Dolan, K. Stephens (Eds.), GeneReviews [Internet]. Seattle, WA: University of Washington, Seattle; 1993–2003 Aug 27 [updated 2010 Apr 13]. Available at http://www.ncbi.nlm.nih.gov/books/NBK1442/.
- Weller, W. E., Minkovitz, C. S., et al. (2003). Utilization of medical and health-related services among school-age children and adolescents with special health care needs (1994 National Health Interview Survey on Disability [NHIS-D] Baseline Data). Pediatrics, 112(3 Pt 1), 593–603.PubMedCrossRefGoogle Scholar