Doshi Pratik, Tilford J Mick, Ounpraseuth Songthip, Kuo Dennis Z, Payakachat Nalin
University of Kentucky, Lexington, KY, USA.
Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Matern Child Health J. 2017 Feb;21(2):351-366. doi: 10.1007/s10995-016-2120-z.
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.
目的 本研究调查了州政府要求私人保险公司为自闭症儿童提供服务是否会影响结果方面的种族差异。方法 本研究使用了2005/2006年和2009/2010年的全国特殊医疗需求儿童调查数据。样本纳入了当前被诊断为自闭症的儿童。居住在14个州和哥伦比亚特区的儿童在2005/2006年调查中未受该要求覆盖，但在2009/2010年调查中受该要求覆盖，作为要求组。居住在32个州的儿童在这两个时间段均未受该要求覆盖，作为对照组。评估的结果指标包括护理质量、家庭经济状况和儿童健康。采用三重差分法（DDD）来评估该要求对结果方面种族差异的影响。结果 在两期数据中，与白人儿童相比，非白人儿童获得以家庭为中心护理的机会较少，但这种差异在要求组和对照组所在州并不明显，因为只有对照组所在州存在显著差异。在各时间段和各分组中，非白人儿童的父母报告的年度自付费用均低于白人儿童的父母。DDD估计未提供证据表明该要求对任何结果指标在改善或加剧种族差异方面有统计学上的显著影响。结论 本研究未发现证据表明州政府对私人保险公司的要求会影响自闭症儿童结果方面的种族差异。
