McBain Ryan K, Cantor Jonathan H, Kofner Aaron, Callaghan Timothy, Stein Bradley D, Yu Hao
RAND Corporation, Boston, USA.
RAND Corporation, Santa Monica, USA.
Autism. 2021 May;25(4):921-931. doi: 10.1177/1362361320976744. Epub 2020 Dec 4.
To improve access to health services for children with autism spectrum disorder, US states have passed laws requiring health insurers to cover autism-related care, commonly known as state insurance mandates. However, the features of mandates differ across states, with some state laws containing very generous provisions and others containing very restrictive provisions such as whether the mandates include children aged above 12 years, whether there is a limit on spending, and whether there are restrictions on the types of services covered. This study examined the relationship between generosity of mandates and growth in the health workforce between 2003 and 2017, a period during which 44 states passed mandates. We found that states that enacted more generous mandates experienced significantly more growth in board-certified behavioral analysts who provide behavioral therapy as well as more growth in child psychiatrists. We did not find differences in the growth of pediatricians, which is a less specialized segment of the workforce. Our findings were consistent across eight different mandate features and suggest that the content of legislation may be as important as whether or not legislation has been passed in terms of encouraging growth in the supply of services for children with autism spectrum disorder.
为改善自闭症谱系障碍儿童获得医疗服务的机会，美国各州已通过法律，要求健康保险公司承保与自闭症相关的护理，即通常所说的州保险授权。然而，各州的授权特征有所不同，一些州法律包含非常宽松的条款，而另一些则包含非常严格的条款，比如授权是否涵盖12岁以上的儿童、是否有支出限制以及对所涵盖服务类型是否有限制。本研究考察了2003年至2017年期间授权的宽松程度与医疗劳动力增长之间的关系，在此期间有44个州通过了授权。我们发现，颁布更宽松授权的州，提供行为疗法的董事会认证行为分析师的增长显著更多，儿童精神科医生的增长也更多。我们没有发现儿科医生增长方面的差异，儿科医生是劳动力中专业性较低的一个群体。我们的研究结果在八种不同的授权特征中都是一致的，这表明在鼓励自闭症谱系障碍儿童服务供给增长方面，立法内容可能与立法是否通过同样重要。
