RAND Corporation, Boston, Massachusetts;
RAND Corporation, Santa Monica, California.
Pediatrics. 2020 Oct;146(4). doi: 10.1542/peds.2020-0836. Epub 2020 Sep 8.
State mandates have required insurance companies to provide coverage for autism-related child health care services; however, it has not been determined if insurance mandates have improved the supply of child health care providers. We investigate the effect of state insurance mandates on the supply of child psychiatrists, pediatricians, and board-certified behavioral analysts (BCBAs).
We used data from the National Conference of State Legislatures and Health Resources and Services Administration's Area Health Resource Files to examine child psychiatrists, pediatricians, and BCBAs in all 50 states from 2003 to 2017. Fixed-effects regression models compared change in workforce density before versus one year after mandate implementation and the effect of mandate generosity across 44 US states implementing mandates between 2003 and 2017.
From 2003 to 2017, child psychiatrists increased from 7.40 to 10.03 per 100 000 children, pediatricians from 62.35 to 68.86, and BCBAs from 1.34 to 29.88. Mandate introduction was associated with an additional increase of 0.77 BCBAs per 100 000 children (95% confidence interval [CI]: 0.18 to 1.42) one year after mandate enactment. Mandate introduction was also associated with a more modest increase among child psychiatrists (95% CI: 0.10 to 0.91) and was not associated with the prevalence of pediatricians (95% CI: -0.76 to 1.13). We also found evidence that more generous mandate benefits were associated with larger effects on workforce supply.
State insurance mandates were associated with an ∼16% increase in BCBAs from 2003 to 2017, but the association with child psychiatrists was smaller and nonsignificant among pediatricians. In these findings, it is suggested that policies are needed that specifically address workforce constraints in the provision of services for children with autism spectrum disorder.
州政府的强制要求保险公司为与自闭症相关的儿童保健服务提供保险；然而，目前还不能确定保险强制要求是否提高了儿童保健提供者的供应。我们调查了州保险强制要求对儿童精神科医生、儿科医生和 board-certified behavioral analysts（BCBAs）供应的影响。
我们使用了 National Conference of State Legislatures 和 Health Resources and Services Administration 的 Area Health Resource Files 的数据，在 2003 年至 2017 年期间检查了所有 50 个州的儿童精神科医生、儿科医生和 BCBAs。固定效应回归模型比较了在实施强制要求之前和一年后劳动力密度的变化，以及在 2003 年至 2017 年期间实施强制要求的 44 个州中，强制要求的慷慨程度的影响。
从 2003 年到 2017 年，儿童精神科医生的数量从每 100000 名儿童 7.40 人增加到 10.03 人，儿科医生的数量从每 100000 名儿童 62.35 人增加到 68.86 人，BCBAs 的数量从每 100000 名儿童 1.34 人增加到 29.88 人。强制要求的引入与授权实施后一年每 100000 名儿童增加 0.77 名 BCBAs 相关（95%置信区间[CI]：0.18 至 1.42）。强制要求的引入也与儿童精神科医生的人数增加有一定的关系（95%CI：0.10 至 0.91），但与儿科医生的数量无关（95%CI：-0.76 至 1.13）。我们还发现证据表明，更慷慨的授权福利与劳动力供应的更大影响有关。
州保险强制要求与 2003 年至 2017 年期间 BCBAs 的增长约 16%有关，但与儿童精神科医生的关联较小，在儿科医生中没有统计学意义。在这些发现中，需要制定专门针对为自闭症谱系障碍儿童提供服务的劳动力限制的政策。
