The Differential Effects of Insurance Mandates on Health Care Spending for Children's Autism Spectrum Disorder.
The Differential Effects of Insurance Mandates on Health Care Spending for Children's Autism Spectrum Disorder.
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DOI：
10.1097/mlr.0000000000000863
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发表时间：
2018-03
期刊：
影响因子：
3
通讯作者：
Mandell DS
中科院分区：
文献类型：
--
作者：
Candon MK;Barry CL;Epstein AJ;Marcus SC;Kennedy-Hendricks A;Xie M;Mandell DS
自闭症谱系障碍（ASD）儿童的治疗强度有很大差异。这项研究询问针对ASD的医疗保健利用的政策是否会基于这种差异对儿童产生不同的影响。具体来说，我们研究了州级保险规定的影响，要求商业保险公司在任何全额保险计划中涵盖某些治疗ASD的方法。利用2008年至2012年间三家国家保险公司的保险索赔，我们采用了差异中的差异方法来比较受强制要求的自闭症儿童和未受强制要求的自闭症儿童。为了考虑差异效应，我们估计了分位数回归，以评估授权对三个结果的支出分布的影响：(1)asd特定门诊服务的月度支出，(2)asd特定住院服务的月度支出，以及(3)精神药物的季度支出。针对自闭症谱系障碍的门诊服务支出的变化是根据儿童的支出水平而变化的。对于那些接受强制要求的ASD儿童，每月在ASD特定门诊支出分布的第95百分位的儿童的支出增加了1,460美元（p<0.001）。相比之下，第五个百分位数的孩子每月的影响仅为2美元（p<0.001）。授权并未显著影响asd特定住院服务或精神药物的支出。州一级的保险规定对那些支出水平较高的孩子有更大的影响。在某种程度上，支出接近治疗强度和ASD的潜在严重程度，这些结果表明，授权针对的是有更大服务需求的儿童。
There is substantial variation in treatment intensity among children with autism spectrum disorder (ASD). This study asks whether policies that target health care utilization for ASD affect children differentially based on this variation. Specifically, we examine the impact of state-level insurance mandates that require commercial insurers to cover certain treatments for ASD for any fully-insured plan. Using insurance claims between 2008 and 2012 from three national insurers, we used a difference-in-differences approach to compare children with ASD who were subject to mandates to children with ASD who were not. To allow for differential effects, we estimated quantile regressions that evaluate the impact of mandates across the spending distributions of three outcomes: (1) monthly spending on ASD-specific outpatient services, (2) monthly spending on ASD-specific inpatient services, and (3) quarterly spending on psychotropic medications. The change in spending on ASD-specific outpatient services attributable to mandates varied based on the child’s level of spending. For those children with ASD who were subject to the mandate, monthly spending for a child in the 95th percentile of the ASD-specific outpatient spending distribution increased by $1,460 (p<0.001). In contrast, the effect was only $2 per month for a child in the 5th percentile (p<0.001). Mandates did not significantly affect spending on ASD-specific inpatient services or psychotropic medications. State-level insurance mandates have larger effects for those children with higher levels of spending. To the extent that spending approximates treatment intensity and the underlying severity of ASD, these results suggest that mandates target children with greater service needs.