Insurance Mandate Generosity, COVID-19, and Health Care for Children with Autism

保险强制慷慨、COVID-19 和自闭症儿童的医疗保健

• 批准号: 10587133
• 负责人: HAO YU
• 金额: $ 62.76万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-14 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10587133
• 关键词: Adopted; Affect; Age; Behavior Therapy; Behavioral; COVID-19; COVID-19 pandemic; Caring; Child; Child health care; Complex; Data; Decision Making; District of Columbia; Exclusion; Goals; Health; Health Benefit; Health Insurance; Health system; Healthcare; Healthcare Systems; Home; Individual; Inpatients; Insurance; Insurance Benefits; Insurance Carriers; Insurance Coverage; Medical; Mental Health Services; Methods; Outpatients; Parents; Pharmacy facility; Policies; Policy Maker; Policy Making; Prevalence; Privatization; Public Health; Quasi-experiment; Reporting; Research Personnel; Services; Statutes and Laws; Structure; Surveys; Tennessee; Time; Variant; Vulnerable Populations; age group; aged; autism spectrum disorder; autistic children; design; developmental disease; fighting; health care availability; health care cost/financing; health care service utilization; improved; insurance claims; interest; knowledge base; medical specialties; meetings; pandemic disease; payment; response; service utilization

PROJECT SUMMARY To reduce the unmet health care needs among children with autism spectrum disorders (ASD), one state-level policy response has been legislations that require private health insurers to provide coverage for ASD-related services, known as state autism insurance mandates. By 2019, insurance mandates were enacted in all states and the District of Columbia. Several studies have documented substantial variations in state autism insurance mandates. However, there is a paucity of evidence about whether children with ASD in the states with more generous mandates have fared better than those living in the states with more limited mandates. Identifying this evidence is of critical importance given the fact that children with ASD have complex health conditions and require affordable, comprehensive insurance coverage to meet their health care needs either under normal circumstances or during unusual times, such as the COVID-19 pandemic. It is also unknown which specific mandate policy features matter most for reducing unmet needs among this group of children and maintaining or increasing their health care utilization during the pandemic. This proposed project aims to fill the evidence gaps by examining each of these issues. Our goal is to contribute to the knowledge base that can inform decision-making on health care financing for children with ASD. Specifically, we will carry out the following Aims: (1) Use national survey data to assess the extent to which more generous state autism mandates improve health care access and reduce unmet needs for children with ASD before the COVID-19 pandemic, (2) Use nation-wide insurance claims data to assess the extent to which more generous state mandates increase service utilization and spending for children with ASD, by setting (outpatient, ED, inpatient, home) and care type (medical, behavioral, pharmacy), before the pandemic, and (3) Use both national survey and claims data to assess whether and to what extent more generous state mandates help maintain or increase access, utilization, and spending for children with ASD from before to during the pandemic. To examine the Aims, we will adopt difference-in-differences and triple-differences approaches, both of which are rigorous quasi-experimental designs. The proposed study is unique in examining how health care for children with ASD is affected by the generosity of state mandates in general and by type of mandate policy feature in specific. The proposed study is timely since its findings have the potential to inform policy-making on expanding insurance benefits and closing coverage gaps for children with ASD as the nation fights the pandemic and potentially embarks on new rounds of health system reform. Our study results will also be relevant to broader debates around optimal design of essential health benefits, a topic of great interest to policy-makers and researchers, especially in the past decade.

项目摘要 为了减少自闭症谱系障碍儿童的未满足医疗保健需求（ASD），一个 州级政策响应是要求私人健康保险公司提供覆盖范围的立法 与ASD相关的服务，称为州自闭症保险。到2019年，保险任务是 在所有州和哥伦比亚特区颁布。几项研究已经记录了有关的实质性差异 州自闭症保险规定。但是，关于ASD儿童是否在 具有更慷慨的州的州比居住在美国的人的表现要好 任务。鉴于ASD患有ASD的孩子复杂的事实，确定这一证据至关重要 健康状况，需要负担得起的全面保险范围以满足其医疗保健需求 无论是在正常情况下还是在异常时期，例如COVID-19大流行。也是 未知哪些特定授权策略特征对于减少这组的未满足需求最重要 儿童并在大流行期间维持或增加其医疗保健利用。 该提议的项目旨在通过检查这些问题中的每一个来填补证据空白。我们的目标是 为知识库做出贡献，可以为儿童提供有关医疗保健融资的决策的知识库 ASD。具体来说，我们将执行以下目的：（1）使用国家调查数据来评估 更慷慨的州自闭症要求改善医疗保健的机会并减少儿童未满足的需求 （2）使用全国性的保险索赔数据来评估范围 更慷慨的州要求增加ASD儿童的服务利用和支出， 在大流行之前，设置（门诊，ed，住院，家庭）和护理类型（医学，行为，药房）， （3）同时使用国家调查和索赔数据来评估是否以及在多大程度上更慷慨的状态 授权有助于维持或增加ASD儿童的访问，利用和支出。 在大流行期间。 为了检查目标，我们将采用差异差异和三差方法，这两种方法 是严格的准实验设计。拟议的研究在检查医疗保健如何为 ASD的儿童一般受国家授权的慷慨影响和授权政策的类型影响 特定功能。拟议的研究是及时的，因为它的发现有可能告知政策制定 随着国家与ASD的儿童抗争，扩大了保险福利和关闭覆盖范围 大流行，并有可能着手进行新的卫生系统改革。我们的研究结果也将是 与有关基本健康益处的最佳设计的更广泛辩论相关，这是一个非常感兴趣的话题 政策制定者和研究人员，尤其是在过去十年中。