Bouder James N, Spielman Stuart, Mandell David S
The Vista Foundation, Hershey, PA, USA.
J Autism Dev Disord. 2009 Jun;39(6):953-7. doi: 10.1007/s10803-009-0701-z. Epub 2009 Feb 13.
Many states are considering legislation requiring private insurance companies to pay for autism-related services. Arguments against mandates include that they will result in higher premiums. Using Pennsylvania legislation as an example, which proposed covering services up to $36,000 per year for individuals less than 21 years of age, this paper estimates potential premium increases. The estimate relies on autism treated prevalence, the number of individuals insured by affected plans, mean annual autism expenditures, administrative costs, medical loss ratio, and total insurer revenue. Current treated prevalence and expenditures suggests that premium increases would approximate 1%, with a lower bound of 0.19% and an upper bound of 2.31%. Policy makers can use these results to assess the cost-effectiveness of similar legislation.
许多州正在考虑立法，要求私人保险公司支付与自闭症相关的服务费用。反对强制规定的理由包括，这将导致保费上涨。以宾夕法尼亚州的立法为例，该立法提议为21岁以下的个人每年提供高达36,000美元的服务覆盖，本文估计了潜在的保费增长。该估计依赖于自闭症治疗患病率、受影响计划所承保的人数、自闭症年均支出、行政成本、医疗损失率以及保险公司总收入。目前的治疗患病率和支出表明，保费增长将接近1%，下限为0.19%，上限为2.31%。政策制定者可以利用这些结果来评估类似立法的成本效益。
