Generosity of state insurance mandates and growth in the workforce for autism spectrum disorder.
Ryan K McBain, Jonathan H Cantor, Aaron Kofner and 3 others
PMID 33274642WHAT IT FOUND
More generous state autism insurance mandates were associated with greater growth in board certified behavioral analysts and child psychiatrists per 100,000 children.
Pediatrician supply did not change. This is an association, not proof the mandates caused the growth.
Key findings
01More generous state autism insurance mandates were associated with higher growth in board certified behavioral analysts and child psychiatrists per 100,000 children, but not pediatricians.
02In the model, states with a generous mandate score of 8 were expected to have 24.95 BCBAs per 100,000 children added from 2003 to 2017, compared with 17.08 in states with no mandates.
03When individual mandate features were examined, generous features were associated with higher BCBAs and child psychiatrists, while restrictive features were associated with higher BCBAs for four features and no child psychiatrist increases.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
This is an observational study, so it cannot show that more generous mandates caused more providers. States with generous mandates may differ in other ways, such as having a more favorable environment for mental health care. The analysis used only a one-year lag after mandates went into effect, which may be too short to capture how new providers enter the workforce. It did not include information on where providers practice or how many patients they see, so provider counts may not match actual service availability. It examined only child psychiatrists, board certified behavioral analysts, and pediatricians, not occupational therapists or speech-language pathologists. Because the data were state-level, there were a limited number of observations and statistical power was constrained. Developmental pediatricians were excluded because they are a small specialized group, so the pediatrician findings do not cover that provider type.
Declared interests
The supplied publication types list NIH extramural research support. No author conflicts of interest statement is included in the supplied text.
The easy way to misread this
Do not conclude that more generous state autism insurance mandates caused more providers for children with autism spectrum disorder. The study is observational, and causality should not be implied.