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(Aut-SDAR) Disparities in Health Care Access and Utilization of Children during Autism Insurance Reform

Abstract

The prevalence of autism spectrum disorder (ASD) has increased rapidly in recent years. At the same time, comprehensive ASD insurance reform laws have been enacted through legislation or administrative mandates in most US states since 2006. Legislation targeted toward private insurance was designed to facilitate access to and coverage of integrated medical and behavioral health services, and can be beneficial to children with ASD who have an unmet need for services. However, research on factors contributing to access and utilization disparities in the US pediatric population during autism insurance reform has been sparse. This proposed study intends to fill this gap through two specific aims: 1) identify the determinants that contribute to disparities in healthcare access and utilization among children with ASD by early and late policy adopting states, and 2) investigate potential changes in hospitalization patterns for children with ASD, prior to and following comprehensive ASD insurance reform. We will use two national representative datasets, the National Survey of Children's Health (NSCH) sponsored by the Maternal and Child Health Bureau of the Health Resources and Services Administration, and Kids' Inpatient Database (KID) sponsored by the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, to accomplish the specific aims of this proposed study. Separate sets of regression models will be developed to examine disparities in health services utilization in children with ASD in order to assess the potential impact of ASD insurance reform associated with various health services. Disparities may affect some groups more than others as ASD insurance reform continues undergo changes. Examination of these disparities is essential to understanding the type of changes needed to better-inform policy, in an effort to reduce disparities among underserved and disadvantaged children and families. The results will provide insight for future studies into potential measures of comparison needed to assess the impact of health care coverage changes on health services utilization.

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