title: Do Insurance Mandates Affect Racial Disparities in Outcomes for Children with Autism?
abstract: Objective The study investigated whether state mandates for private insurers to provide services for children with autism influence racial disparities in outcomes. Methods The study used 2005/2006 and 2009/2010 waves of the National Survey of Children with Special Health Care Needs. Children with a current diagnosis of autism were included in the sample. Children residing in 14 states and the District of Columbia that were not covered by the mandate in the 2005/2006 survey, but were covered in the 2009/2010 survey, served as the mandate group. Children residing in 32 states that were not covered by a mandate in either wave served as the comparison group. Outcome measures assessed included care quality, family economics, and child health. A difference-in-difference-in-differences (DDD) approach was used to assess the impact of the mandates on racial disparities in outcomes. Results Non-white children had less access to family-centered care compared to white children in both waves of data, but this difference was not apparent across mandate and comparison states as only the comparison states had significant differences. Parents of non-white children reported paying less in annual out-of-pocket expenses compared to parents of white children across waves and groups. DDD estimates did not provide evidence that the mandates had statistically significant effects on improving or worsening racial disparities for any outcome measure. Conclusions This study did not find evidence that state mandates on private insurers affected racial disparities in outcomes for children with autism.
authors.affiliation: University of Kentucky, Lexington, KY, USA.
authors.forename: Pratik
authors.initials: P
authors.lastname: Doshi
authors.affiliation: Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: J Mick
authors.initials: JM
authors.lastname: Tilford
authors.affiliation: Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Songthip
authors.initials: S
authors.lastname: Ounpraseuth
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Dennis Z
authors.initials: DZ
authors.lastname: Kuo
authors.affiliation: Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 W. Markham St, 522, Little Rock, AR, USA. npayakachat@uams.edu.
authors.forename: Nalin
authors.identifier: http://orcid.org/0000-0002-9526-5356
authors.initials: N
authors.lastname: Payakachat
mesh_terms: D000293:Adolescent; D001321:Autistic Disorder / Q000191:economics* / Q000453:epidemiology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007223:Infant; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D037141:Mandatory Programs / Q000706:statistics & numerical data*; D063868:Patient Outcome Assessment; D011203:Poverty / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D063505:Racism / Q000208:ethnology / Q000706:statistics & numerical data; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data
keywords: Children with autism; NS-CSHCN; Private insurers; Racial disparities; State mandates