The Differential Effects of Insurance Mandates on Health Care Spending for Children's Autism Spectrum Disorder

Molly K. Candon, Colleen L. Barry, Andrew J. Epstein, Steven C. Marcus, Alene Kennedy-Hendricks, Ming Xie, David S. Mandell

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Objectives: There is substantial variation in treatment intensity among children with autism spectrum disorder (ASD). This study asks whether policies that target health care utilization for ASD affect children differentially based on this variation. Specifically, we examine the impact of state-level insurance mandates that require commercial insurers to cover certain treatments for ASD for any fully-insured plan. Methods: Using insurance claims between 2008 and 2012 from three national insurers, we used a difference-in-differences approach to compare children with ASD who were subject to mandates to children with ASD who were not. To allow for differential effects, we estimated quantile regressions that evaluate the impact of mandates across the spending distributions of three outcomes: (1) monthly spending on ASD-specific outpatient services; (2) monthly spending on ASD-specific inpatient services; and (3) quarterly spending on psychotropic medications. Results: The change in spending on ASD-specific outpatient services attributable to mandates varied based on the child's level of spending. For those children with ASD who were subject to the mandate, monthly spending for a child in the 95th percentile of the ASD-specific outpatient spending distribution increased by $1460 (P<0.001). In contrast, the effect was only $2 per month for a child in the fifth percentile (P<0.001). Mandates did not significantly affect spending on ASD-specific inpatient services or psychotropic medications. Conclusions: State-level insurance mandates have larger effects for those children with higher levels of spending. To the extent that spending approximates treatment intensity and the underlying severity of ASD, these results suggest that mandates target children with greater service needs.

Original languageEnglish (US)
Pages (from-to)228-232
Number of pages5
JournalMedical care
Issue number3
StatePublished - 2018


  • Autism spectrum disorders
  • insurance mandates
  • quantile regressions

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'The Differential Effects of Insurance Mandates on Health Care Spending for Children's Autism Spectrum Disorder'. Together they form a unique fingerprint.

Cite this