Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Leonard Davis Institute of Health Economics, Philadelphia.
J Am Acad Child Adolesc Psychiatry. 2018 Feb;57(2):125-131. doi: 10.1016/j.jaac.2017.10.019. Epub 2017 Dec 5.
Many states with mandates requiring commercial insurers to cover autism spectrum disorder (ASD) health services specify upper age limits above which coverage is no longer mandated. It is unknown what effects these age caps have on health service use and spending among adolescents who have exceeded the age cap.
Using administrative claims data from 3 national commercial insurers, a difference-in-differences approach was used to estimate effects of age caps on health service use and spending among adolescents with ASD. Statistical models compared changes in use and spending between those above versus below the age cap among individuals eligible versus ineligible for mandated coverage. The analytic sample included data from 2008 through 2012 on 7,845 individuals (151,976 person-months) ages 10 to 21 years in 11 states imposing mandate age caps going into effect during adolescence.
Age caps were associated with 4.2 percentage point (95% CI = -7.0, -1.5) lower probability of any ASD-specific service use in a month and $69 less (95% CI = -112, -$26) in average monthly spending on ASD-specific services than would have been expected given concomitant pre-post age cap differences among individuals in the same states who were never eligible for mandate-covered services. In addition, age caps were associated with $99 (95% CI = -$168, -$30) lower average monthly spending on all health care services.
Insurance mandates that include age caps going into effect during adolescence reduce health service use and spending among individuals with ASD during a critical phase of the life course.
许多要求商业保险公司覆盖自闭症谱系障碍（ASD）健康服务的州都规定了覆盖范围不再强制要求的上限年龄。目前尚不清楚这些年龄上限对超过年龄上限的青少年的健康服务使用和支出有什么影响。
利用来自 3 家全国性商业保险公司的行政索赔数据，采用差异中的差异方法来估计年龄上限对患有 ASD 的青少年健康服务使用和支出的影响。统计模型比较了符合和不符合强制性覆盖条件的个体中，处于年龄上限以上和以下的个体之间使用和支出的变化。分析样本包括 2008 年至 2012 年来自 11 个州的 7845 名年龄在 10 至 21 岁的个人（151976 人/月）的数据，这些州在青春期实施了强制性年龄上限。
年龄上限与任何一个月内接受任何特定 ASD 服务的可能性降低了 4.2 个百分点（95%CI=-7.0，-1.5），与州内从未有资格获得覆盖服务的相同人群相比，特定 ASD 服务的平均月支出减少了 69 美元（95%CI=-112，-26）。此外，年龄上限与所有医疗保健服务的平均月支出减少了 99 美元（95%CI=-168，-30）。
在青春期实施的包含年龄上限的保险强制规定减少了患有 ASD 的个体在生命过程中的关键阶段的健康服务使用和支出。
