title: The difference in medical utilization and associated factors between children and adolescents with and without autism spectrum disorders.
abstract: This study determined differences in health care utilization and health care expenditures between children with and without autism spectrum disorder (ASD) and examined possible reasons for these differences. A retrospective longitudinal study of children aged younger than 18 years both with and without ASD was conducted using the 2008 database of the Ministry of the Interior registry of the disabled persons in tandem with the National Health Insurance Research Database. Propensity score matching for the covariates of age, sex, and parental monthly salary was used to match children at a ratio of 1:3 for observing health care utilization among children with and without ASD from 2008 to 2011. Generalized estimating equation analysis was performed to determine factors that affect health care utilization, such as physician visits, emergency room (ER) visits, hospitalizations, and health care expenditures. After matching was completed, the sample size comprised 3280 children with ASD and 9840 children without ASD. Among the children in the sample, most were boys (86.68%) between the ages of 6-11 years, and the average age of both samples was 9.8 years. After relevant factors were controlled for, the children with ASD yielded an average of 14.2 more annual physician visits and were more likely to visit the ER (OR=1.12, P<.05) or be hospitalized (OR=1.48; P<.05) compared with the children without ASD. Compared with the children without ASD, the children with ASD exhibited higher annual physician visit expenditures (NT$26,580 more), higher ER visit expenditures (NT$50 more), higher hospitalization expenditures (NT$5830 more), and NT$32,460 more total health care expenditures (all P<.05). Significant predictors of health care expenditures among the children with ASD were age, parental monthly salary, and severity of comorbidity. The most common reasons for physician visits or hospitalizations among the children with ASD were psychiatric illnesses, respiratory illnesses, and digestive illnesses. The children without ASD most commonly experienced respiratory, digestive, and nervous system or sense organ illnesses. Health care utilization among children with ASD is higher than that among children without ASD. The results of this study can serve as a reference for governmental agencies enacting relevant health care policies.
authors.affiliation: Department of Healthcare Administration, China Medical University, Taichung, Taiwan, ROC; Department of Accounting, China Medical University Hospital, Taichung, Taiwan, ROC.
authors.forename: Ching-Mien
authors.initials: CM
authors.lastname: Wu
authors.affiliation: Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC.
authors.forename: Pei-Tseng
authors.initials: PT
authors.lastname: Kung
authors.affiliation: Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC.
authors.forename: Chia-Ing
authors.initials: CI
authors.lastname: Li
authors.affiliation: Department of Healthcare Administration, China Medical University, Taichung, Taiwan, ROC. Electronic address: wtsai@mail.cmu.edu.tw.
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Tsai
keywords: Autism spectrum disorder (ASD); Children and adolescents; Health care expenditures; Health care utilization