Do Insurance Mandates Affect Racial Disparities in Outcomes for Children with Autism?
- 546 Downloads
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.
KeywordsRacial disparities Children with autism State mandates Private insurers NS-CSHCN
Compliance with Ethical Standards
Conflict of interest
All authors report no competing interest.
- 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
- 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.Google Scholar
- 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
- 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.CrossRefPubMedGoogle 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.Google Scholar
- 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
- 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.CrossRefPubMedGoogle 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.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.Google Scholar