Insurance mandates lead to more children diagnosed and treated for autism spectrum disorder

PHILADELPHIA -State mandates requiring commercial health plans to cover the cost of services for children with autism spectrum disorder (ASD) have resulted in an increased number of children being diagnosed and treated for ASD, according to new research from the Perelman School of Medicine at the University of Pennsylvania. The findings will be published in the July 11th issue of JAMA Pediatrics.

ASD is characterized by impairments in social communication and repetitive behaviors. Its incidence has risen from one in 150 children in 2004 to one in 68 children in 2010. Treatment can require up to 25 hours per week of educational and behavioral interventions for several years. Until recently, the high costs associated with care for children with ASD were not covered by most commercial insurance plans.

In 2001, Indiana became the first state to mandate that behavioral treatments for ASD be covered through commercial health insurance benefits; many other states followed suit starting in 2008. Currently, 44 states have implemented an autism mandate with the idea that it would remove the financial barrier to families that had prevented many children from being diagnosed and treated for ASD.

pic David Mandell is a professor of Psychiatry and director of the Center for Mental Health Policy and Services Research at the Perelman School of Medicine at the University of Pennsylvania. Credit: Penn Medicine

But, is it working?

A team from Penn's department of Psychiatry, led by David Mandell, ScD, a professor and director of the Center for Mental Health Policy and Services Research, are the first to embark on research to find out.

Mandell and colleagues examined inpatient and outpatient health insurance claims for children 21 years and younger covered by three of the largest insurers in the U.S. - United HealthCare, Aetna and Humana - from January 2008 through December 2012.

During the study period, 154,089 of the 1,046,850 children in the sample were diagnosed with ASD. In states with ASD insurance mandates, the adjusted prevalence of children diagnosed with ASD was 1.8 per 1,000, compared with 1.6 per 1,000 children in states without a mandate. Overall, the mandates resulted in a 12.7 percent adjusted increase in prevalence of children diagnosed with ASD.

In addition, the researchers noted that the effects of the mandates increased the longer they remained in effect. In the first year of implementation, mandates were associated with a 10.4 percent increase in the proportion of children diagnosed with ASD; in the second year of implementation, this percentage rose to 17.1 and then to 18 percent in later years.

"These are encouraging findings," Mandell said. "We now know that more children are being served, but we are also acutely aware that these numbers are well below the prevalence of ASD in our society, indicating that the mandates have not had the full effect that advocates desired," he explained. "This is merely a step in the right direction. These mandates represent a patch, not a panacea."

source: University of Pennsylvania School of Medicine