Association of Insurance Type and Cost, Use, Accessibility, and Outcomes of Services for Children with ASD

Background:

Therapeutic care for a child with autism is often extremely complex, entailing a high rate of service utilization and a multifaceted approach to treatment. In turn, parents of children with autism often report problems with accessibility, coordination, and family-centeredness of care, as well as problems with adequacy of insurance coverage. Despite the apparent interrelatedness of these issues, research into the association between insurance coverage and indirect costs, outcomes, and accessibility of services for children with autism is lacking.

Objectives:

The purpose of this study is to compare private and public insurance coverage for children with autism in terms of several interdependent variables -- (a) out-of-pocket expenditures, (b) variety of services used, (c) access to services, (d) child and family outcomes of services, and (e) satisfaction with the payer of services. Due to the exploratory nature of this study, no directional hypotheses were proposed.

Methods:

This study is a secondary analysis of a larger examination of parent and caregiver experiences with the service system in one state (further details on methods are reported in Ruble and McGrew (2007)). The 43-item survey regarding services received in the prior 6 months was distributed to parents/caregivers of children with ASD through direct dissemination at parent support groups, at a special educator meeting, via mail using state databases of community mental health centers, via the internet for autism listservs, and via a web-based version of the survey. Items from the survey were used to construct the five variables to be evaluated against type of insurance: (a) out-of-pocket expenditures, (b) variety of services used, (c) access to services, (d) child and family outcomes of services, and (e) satisfaction with the payer of services. The questionnaire targeted nine specific services - inpatient care, medication management, counseling or training, individual therapy, in-home behavior therapy, speech and language therapy, occupational therapy, case management, respite care, and contained one set of questions for “other service.”

Results:

Of all respondents (n=107), 70.8% were privately insured while 19.5% were publicly insured (9.7% did not report insurance type). No statistically significant differences in out-of-pocket expense, variety of services used, child and family outcomes, or satisfaction with payer were found among privately and publicly insured children. However, a Mann-Whitney U test did reveal that publicly insured children used significantly more medications than did privately insured children (p=0.028). Also, an independent-samples t-test revealed that mean ratings on the access to services subscale (Cronbach’s alpha = 0.703) were significantly higher among privately insured children than publicly insured children (p=.036).

Conclusions:

Among parents of children with autism residing in the state of, private and public insurance coverage is similar in terms of out-of-pocket expense, variety of services used, child and family outcomes of services, and satisfaction with payer. However, parents of privately insured children with autism may have better access to services than do parents of publicly insured children.