Behavioral Pediatrics Meets Behavioral Economics: Autism, Mandates, and High Deductibles

Abstract

* Abbreviation: ASD — : autism spectrum disorder We do not yet know what causes autism spectrum disorder (ASD), but we do know that early intensive behavioral intervention for children with ASD can improve outcomes.1,2 The cost is high, but, from a societal point of view, the benefit will likely outweigh the cost both financially and clinically.3,4 Yet financial barriers, particularly among patients with private insurance, can prevent children and families from receiving needed services.5 Recognizing this, policy makers in many states passed laws mandating that commercial insurers cover ASD-specific interventions. Mandates improved access to care by increasing use of ASD-specific services, particularly in younger children, suggesting that the new policy was effective and increased access to autism treatment of children covered by commercial insurance.6 In addition, more children were diagnosed with ASD in the states with ASD mandates, suggesting that providers were more likely to make the diagnosis when the payment system allowed for early treatment.7 Neither of these findings are surprising; the experience with Medicaid’s Early and Periodic Screening Diagnostic and Treatment suggested that expanding benefits expands access.8 … Address correspondence to David Keller, MD, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 E 16th Ave, B065, Denver, CO 80045. E-mail: david.keller{at}childrenscolorado.org