Service Delivery

Medical expenditures for children with an autism spectrum disorder in a privately insured population.

Shimabukuro et al. (2008) · Journal of autism and developmental disorders 2008
★ The Verdict

Private insurers pay 4–6× more for kids with autism, so wave this paper when you fight for bigger budgets.

✓ Read this if BCBAs who write treatment authorizations or insurance appeals.
✗ Skip if Clinicians who only take cash or work outside the US.

01Research in Context

01

What this study did

Gaynor et al. (2008) looked at medical bills for kids with autism who had private insurance.

They compared yearly spending for these kids to spending for kids without autism.

02

What they found

Kids with autism cost 4–6 times more per year than other kids on the same plans.

The study shows the heavy price tag insurers face when covering autism care.

03

How this fits with other research

Reyer et al. (2006) found a 10× jump in Medicaid costs, almost all from psychiatric hospital stays. The 4–6× gap in private plans looks smaller, but both studies agree: autism care is pricey.

Ohan et al. (2015) surveyed families and showed private insurance often pushes costs back to parents. The insurer sees 4–6× bills, yet families still feel the pinch out-of-pocket.

Leigh et al. (2015) used numbers like these to forecast national autism costs hitting $461 billion by 2025. The 4–6× multiplier helps explain why the total keeps climbing.

04

Why it matters

Use these cost facts when you write justification letters for ABA hours, equipment, or respite funds. A short line like "privately insured kids with autism cost 4–6× more" can sway reviewers who control the purse strings.

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Add the 4–6× cost stat to your next funding request letter.

02At a glance

Intervention
not applicable
Design
other
Population
autism spectrum disorder
Finding
not reported

03Original abstract

This study provides estimates of medical expenditures for a subset of children and adolescents who receive employer-based health insurance and have a medical diagnosis of an autism spectrum disorder (ASD). Data analyzed were from the 2003 MarketScan research databases. Individuals with an ASD had average medical expenditures that exceeded those without an ASD by $4,110-$6,200 per year. On average, medical expenditures for individuals with an ASD were 4.1-6.2 times greater than for those without an ASD. Differences in median expenditures ranged from $2,240 to $3,360 per year with median expenditures 8.4-9.5 times greater. These findings add to a growing body of evidence that children and adolescents with medical diagnoses of an ASD incur elevated medical utilization and costs.

Journal of autism and developmental disorders, 2008 · doi:10.1007/s10803-007-0424-y