International Meeting for Autism Research: A Systematic Review of the Disparities in Health Care Utilization, Expenditures, and Access for Individuals with Autism Spectrum Disorders

A Systematic Review of the Disparities in Health Care Utilization, Expenditures, and Access for Individuals with Autism Spectrum Disorders

Friday, May 21, 2010
Franklin Hall B Level 4 (Philadelphia Marriott Downtown)
11:00 AM
M. K. Tregnago , Health Management & Informatics, University of Missouri, Columbia, MO
Background: Individuals with autism spectrum disorders (ASD) are provided with a variety of interventions and services for treatment of a range of medical, behavioral, and psychological symptoms (Myers & Plauché Johnson, 2007).  It is for this reason that it is hypothesized that children with ASD utilize more healthcare services and therefore have higher healthcare expenditures than children without ASD.  
Objectives: The objective of this research was to conduct a systematic review of the literature to determine whether differences exist for children with ASD versus children without ASD with respect to the use of, the amount of money spent on, and access to health care services; and access to medical home components.
Methods: Medline and PsycInfo databases were searched for studies that were published between 1999 and August 1, 2009, written in the English language, and conducted with a sample in the United States.  Studies included in the review had to incorporate an ASD-only group and compare it with other groups of children without ASD.  Search terms included population variables (e.g. “autism spectrum disorders” or “pervasive developmental disorders”) and outcome variables of interest (e.g. “disparities,” “health care costs,” “health care accessibility,” etc.).
Results: A total of 301 unique articles were located.  From the results, 10 articles were selected based upon the inclusion criteria.  One additional study was selected from the references of these ten.  Resulting articles compared individuals under the age of 21 with an ASD diagnosis to children without autism and/or to children with other special health care needs (OSHCN).  Eligible articles were separated into three distinct categories.  Six studies addressed health care utilization, eight addressed health care expenditures, and three addressed service access issues and medical homeness.  
Conclusions: The results of this review support the hypothesis that there are disparities between children with ASD and children without ASD or with OSHCN in the following areas: access to and utilization of healthcare, healthcare costs, and the tendency to have a medical home.  Compared to children without autism, children with ASD tend to have higher utilization rates of pharmaceuticals as well as inpatient, outpatient, emergency, and special services.  Children with ASD also tend to have higher health care costs than children without autism or with OSHCN, especially for outpatient visits, pharmaceuticals, and special services.  Families of children with ASD were more likely to report having trouble accessing care, especially subspecialty care, and were less likely to report having components of a medical home.  These results have vast implications for autism research and insurance policy, as they show that children with autism appear to utilize additional medical services and have higher costs in some areas relative to other children.  Future research should examine child and family characteristics to determine which variables correlate with higher utilization rates and expenditures.
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