Variables Associated with Coverage for Educational, Mental Health, and Medical Services in Autism Spectrum Disorder

Background:  The rising prevalence of ASD has been associated with increased healthcare expenditures in the United States and United Kingdom. Recent reports also suggest differential burden on public aid relative to private insurance companies with fewer services covered by private insurance in the U.S. In addition to systems level variables, demographic variables associated with coverage have potential to inform policy, improve access, and reduce economic burden related to ASD. For example, literature in pediatric mental health care has identified multiple variables influencing service coverage. Contrastingly, diagnostic and demographic variables associated with service coverage in ASD are not well known.  

Objectives:  To explore potential demographic variables affecting service coverage and out-of-pocket expenditures in individuals with autism spectrum disorder (ASD), ASD and comorbid psychiatric conditions, and control groups.  

Methods:  Surveys were posted on institutional webpages and available for completion via the phone. Parents/caregivers (n=571) completed survey questions related to services sought, received, covered by insurance, and out-of-pocket expenses for dependents. Comparisons were made across four diagnostic groups: ASD (n=355), ASD/Psychiatric (n=101), non-ASD developmental disorders (DD, n= 41), and non-DD psychiatric disorders (n=94). Logistic regressions were completed to examine relationships between diagnosis, age, race, and income on healthcare coverage. Household income, age, and race were evenly distributed across diagnostic categories. Data are presented here from logistic regressions for three service categories: Educational, Mental health, and Medical/Auxiliary services. 

Results:  Coverage for educational services was predicted by diagnosis only. Individuals with ASD were two times more likely to receive coverage for educational services relative to control groups (odds ratio = 2.01). Mental health services were predicted by diagnosis, race, and age.  For ASD, the odds ratio was 0.60, indicating dependents with ASD were 40% less likely to receive coverage for mental heath services sought. Dependents who were Caucasian were 60% more likely to receive coverage for mental health services (odds ratio = 1.60). As individuals grew older, the likelihood of receiving coverage for mental health services increased by 43% per age group (odds ratio = 1.43). Dependents in the ASD/Psychiatric diagnostic category were nearly three times as likely to receive coverage for medical/auxiliary services sought (odds ratio = 2.67).  

Conclusions:  Survey data indicate psychiatric comorbidity, age, and race were associated with service coverage for individuals with ASD. Caregivers of dependents with ASD reported higher rates of coverage for educational services relative to psychiatric and DD controls.  Substantially higher rates of medical service coverage were associated with ASD and psychiatric comorbidity. Taken together with age-related findings on mental health coverage, data suggest potential to improve healthcare access via mental health delivery systems in pediatric ASD. Results also support well known findings of racial disparities in mental health care and a need for culturally sensitive diagnostic and educational programming in minority communities to improve awareness about psychiatric comorbidities in ASD.