Changes in healthcare expenditures after the autism insurance mandate

Li Wang, Junyi Ma, Ruchita Dholakia, Callie Howells, Yun Lu, Chen Chen, Runze Li, Michael Murray, Douglas Leslie

Research output: Contribution to journalArticle

Abstract

Background: In recent years, most U.S. states have passed autism mandates requiring private insurers to cover autism spectrum disorders (ASD). Little is known about the post-mandate changes in healthcare expenditures. Method: This study utilized 2006–2012 de-identified insurance claims data from the largest private insurer in Pennsylvania (PA), where the mandate went into effect in mid 2009. Healthcare expenditures were defined as the amount the insurer paid for healthcare services and were adjusted to 2012 price level. A mixed effects model was used to analyze the expenditures. Results: A total of 9471 children with ASD were included. Although the pre-mandate total expenditures per child with ASD were similar, the post-mandate expenditures significantly increased for groups subject to the autism mandate (87% increase from $7754 in 2008 to $14,486 in 2010) compared to the exempt groups (27% increase from $7238 to $9171). By insurance type, the change from 2008 to 2010 in ASD-related expenditures per child with ASD was $8439 for fully insured large employer sponsored plans and $43 for the Children's Health Insurance Program (CHIP), both subject to the PA mandate; and $2631 for the self-insured, $980 for small-employers, and $-92 for individual plans, all of which are exempt from the mandate. These increases were due to outpatient services but not inpatient or drug costs. Conclusions: Healthcare expenditures increased significantly following the PA autism mandate. Nonexempt, large employer groups had the largest increase in spending. Some exempt, self-insured companies may have voluntarily covered ASD services, leading to a moderate increase.

LanguageEnglish (US)
Pages97-104
Number of pages8
JournalResearch in Autism Spectrum Disorders
Volume57
DOIs
StatePublished - Jan 1 2019

Fingerprint

Autistic Disorder
Health Expenditures
Insurance
Delivery of Health Care
Insurance Carriers
Drug Costs
Ambulatory Care
Autism Spectrum Disorder
Inpatients

All Science Journal Classification (ASJC) codes

  • Developmental and Educational Psychology
  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Wang, L., Ma, J., Dholakia, R., Howells, C., Lu, Y., Chen, C., ... Leslie, D. (2019). Changes in healthcare expenditures after the autism insurance mandate. Research in Autism Spectrum Disorders, 57, 97-104. https://doi.org/10.1016/j.rasd.2018.10.004
Wang, Li ; Ma, Junyi ; Dholakia, Ruchita ; Howells, Callie ; Lu, Yun ; Chen, Chen ; Li, Runze ; Murray, Michael ; Leslie, Douglas. / Changes in healthcare expenditures after the autism insurance mandate. In: Research in Autism Spectrum Disorders. 2019 ; Vol. 57. pp. 97-104.
@article{ee83ee3f510c4df38f6370b5faef02a7,
title = "Changes in healthcare expenditures after the autism insurance mandate",
abstract = "Background: In recent years, most U.S. states have passed autism mandates requiring private insurers to cover autism spectrum disorders (ASD). Little is known about the post-mandate changes in healthcare expenditures. Method: This study utilized 2006–2012 de-identified insurance claims data from the largest private insurer in Pennsylvania (PA), where the mandate went into effect in mid 2009. Healthcare expenditures were defined as the amount the insurer paid for healthcare services and were adjusted to 2012 price level. A mixed effects model was used to analyze the expenditures. Results: A total of 9471 children with ASD were included. Although the pre-mandate total expenditures per child with ASD were similar, the post-mandate expenditures significantly increased for groups subject to the autism mandate (87{\%} increase from $7754 in 2008 to $14,486 in 2010) compared to the exempt groups (27{\%} increase from $7238 to $9171). By insurance type, the change from 2008 to 2010 in ASD-related expenditures per child with ASD was $8439 for fully insured large employer sponsored plans and $43 for the Children's Health Insurance Program (CHIP), both subject to the PA mandate; and $2631 for the self-insured, $980 for small-employers, and $-92 for individual plans, all of which are exempt from the mandate. These increases were due to outpatient services but not inpatient or drug costs. Conclusions: Healthcare expenditures increased significantly following the PA autism mandate. Nonexempt, large employer groups had the largest increase in spending. Some exempt, self-insured companies may have voluntarily covered ASD services, leading to a moderate increase.",
author = "Li Wang and Junyi Ma and Ruchita Dholakia and Callie Howells and Yun Lu and Chen Chen and Runze Li and Michael Murray and Douglas Leslie",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.rasd.2018.10.004",
language = "English (US)",
volume = "57",
pages = "97--104",
journal = "Research in Autism Spectrum Disorders",
issn = "1750-9467",
publisher = "Elsevier BV",

}

Wang, L, Ma, J, Dholakia, R, Howells, C, Lu, Y, Chen, C, Li, R, Murray, M & Leslie, D 2019, 'Changes in healthcare expenditures after the autism insurance mandate' Research in Autism Spectrum Disorders, vol. 57, pp. 97-104. https://doi.org/10.1016/j.rasd.2018.10.004

Changes in healthcare expenditures after the autism insurance mandate. / Wang, Li; Ma, Junyi; Dholakia, Ruchita; Howells, Callie; Lu, Yun; Chen, Chen; Li, Runze; Murray, Michael; Leslie, Douglas.

In: Research in Autism Spectrum Disorders, Vol. 57, 01.01.2019, p. 97-104.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Changes in healthcare expenditures after the autism insurance mandate

AU - Wang, Li

AU - Ma, Junyi

AU - Dholakia, Ruchita

AU - Howells, Callie

AU - Lu, Yun

AU - Chen, Chen

AU - Li, Runze

AU - Murray, Michael

AU - Leslie, Douglas

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: In recent years, most U.S. states have passed autism mandates requiring private insurers to cover autism spectrum disorders (ASD). Little is known about the post-mandate changes in healthcare expenditures. Method: This study utilized 2006–2012 de-identified insurance claims data from the largest private insurer in Pennsylvania (PA), where the mandate went into effect in mid 2009. Healthcare expenditures were defined as the amount the insurer paid for healthcare services and were adjusted to 2012 price level. A mixed effects model was used to analyze the expenditures. Results: A total of 9471 children with ASD were included. Although the pre-mandate total expenditures per child with ASD were similar, the post-mandate expenditures significantly increased for groups subject to the autism mandate (87% increase from $7754 in 2008 to $14,486 in 2010) compared to the exempt groups (27% increase from $7238 to $9171). By insurance type, the change from 2008 to 2010 in ASD-related expenditures per child with ASD was $8439 for fully insured large employer sponsored plans and $43 for the Children's Health Insurance Program (CHIP), both subject to the PA mandate; and $2631 for the self-insured, $980 for small-employers, and $-92 for individual plans, all of which are exempt from the mandate. These increases were due to outpatient services but not inpatient or drug costs. Conclusions: Healthcare expenditures increased significantly following the PA autism mandate. Nonexempt, large employer groups had the largest increase in spending. Some exempt, self-insured companies may have voluntarily covered ASD services, leading to a moderate increase.

AB - Background: In recent years, most U.S. states have passed autism mandates requiring private insurers to cover autism spectrum disorders (ASD). Little is known about the post-mandate changes in healthcare expenditures. Method: This study utilized 2006–2012 de-identified insurance claims data from the largest private insurer in Pennsylvania (PA), where the mandate went into effect in mid 2009. Healthcare expenditures were defined as the amount the insurer paid for healthcare services and were adjusted to 2012 price level. A mixed effects model was used to analyze the expenditures. Results: A total of 9471 children with ASD were included. Although the pre-mandate total expenditures per child with ASD were similar, the post-mandate expenditures significantly increased for groups subject to the autism mandate (87% increase from $7754 in 2008 to $14,486 in 2010) compared to the exempt groups (27% increase from $7238 to $9171). By insurance type, the change from 2008 to 2010 in ASD-related expenditures per child with ASD was $8439 for fully insured large employer sponsored plans and $43 for the Children's Health Insurance Program (CHIP), both subject to the PA mandate; and $2631 for the self-insured, $980 for small-employers, and $-92 for individual plans, all of which are exempt from the mandate. These increases were due to outpatient services but not inpatient or drug costs. Conclusions: Healthcare expenditures increased significantly following the PA autism mandate. Nonexempt, large employer groups had the largest increase in spending. Some exempt, self-insured companies may have voluntarily covered ASD services, leading to a moderate increase.

UR - http://www.scopus.com/inward/record.url?scp=85055493884&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055493884&partnerID=8YFLogxK

U2 - 10.1016/j.rasd.2018.10.004

DO - 10.1016/j.rasd.2018.10.004

M3 - Article

VL - 57

SP - 97

EP - 104

JO - Research in Autism Spectrum Disorders

T2 - Research in Autism Spectrum Disorders

JF - Research in Autism Spectrum Disorders

SN - 1750-9467

ER -