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.

项目概要 为了减少自闭症谱系障碍 (ASD) 儿童未得到满足的医疗保健需求，一项 州一级的政策反应是立法要求私人医疗保险公司为以下人群提供保险 与自闭症谱系障碍 (ASD) 相关的服务，称为国家自闭症保险规定。到 2019 年，保险授权已 在所有州和哥伦比亚特区颁布。多项研究记录了显着差异 国家自闭症保险规定。然而，关于自闭症儿童是否患有自闭症谱系障碍（ASD）儿童，目前还缺乏证据。 拥有更慷慨授权的国家比那些授权更有限的国家表现得更好 授权。鉴于患有自闭症谱系障碍 (ASD) 的儿童具有复杂的心理特征，识别这一证据至关重要。 健康状况，需要负担得起的全面保险来满足他们的医疗保健需求 无论是在正常情况下还是在非常时期（例如 COVID-19 大流行）。这也是 不知道哪些具体任务政策特征对于减少这一群体中未满足的需求最重要 儿童并在大流行期间维持或增加他们的医疗保健利用率。 该拟议项目旨在通过检查每个问题来填补证据空白。我们的目标是 为知识库做出贡献，为患有儿童的医疗保健筹资决策提供信息 自闭症谱系障碍。具体来说，我们将实现以下目标：（1）利用全国调查数据来评估 哪些国家对自闭症患者更加慷慨，要求改善医疗保健的可及性并减少儿童未得到满足的需求 在 COVID-19 大流行之前与 ASD 合作，(2) 使用全国范围的保险索赔数据来评估 更慷慨的州政府要求增加自闭症谱系障碍儿童的服务利用率和支出， 大流行之前的环境（门诊、急诊室、住院、家庭）和护理类型（医疗、行为、药房）， (3) 使用国家调查和索赔数据来评估国家是否以及在多大程度上更加慷慨 任务有助于维持或增加自闭症谱系障碍儿童从以前到现在的获取、利用和支出 疫情期间。 为了检验目标，我们将采用双重差分法和三重差分法，这两种方法 这是严格的准实验设计。拟议的研究在研究医疗保健如何 患有自闭症谱系障碍 (ASD) 的儿童受到国家总体授权和授权政策类型的影响 特点具体。拟议的研究是及时的，因为其研究结果有可能为政策制定提供信息 随着国家抗击自闭症谱系障碍，扩大保险福利并缩小自闭症谱系障碍儿童的承保缺口 大流行并可能开始新一轮的卫生系统改革。我们的研究成果也将 与围绕基本健康福利的优化设计的更广泛辩论相关，这是人们非常感兴趣的话题 政策制定者和研究人员，特别是在过去十年。