By Monica E. Oss, Chief Executive Officer, OPEN MINDS
Autism is certainly making the national news. As our team was pulling together this overview of new developments in autism, the news outlets were covering the pending report from the Department of Health & Human Services that autism is linked to Tylenol use during pregnancy. But there are skeptics—Dr. Gupta on Tylenol Use During Pregnancy and Autism: This Is Not a Cause-and-Effect Relationship.
While the scientific and political communities debate the causes of autism, a new report—Treatment And Health Expenditures Among Children With Autism Spectrum Disorder, U.S. Civilian Noninstitutionalized Population, 2018-2022—provides an update on autism prevalence and costs. Between 2011 and 2022, the diagnosis rate of autism spectrum disorder (ASD) increased by 207% and 143%, respectively, for children 5 to 8 years (30.3 per 1,000 children) and 9 to 12 years (22.1 per 1,000 children).
In addition to increasing prevalence, there are also the increasing costs of providing health care for people with autism. The average total health expenditure for children who had received treatment was $20,122, and ASD-specific expenditures were $14,048. Average total spending on children who did not receive ASD treatment was $2,201. When filtered by insurance, the average spending for children with private insurance was $23,858 when treated for ASD and $2,579 without that treatment. For children with public insurance, the cost of treated versus non-treated dropped to $15,544 and $1,662, respectively.
Of those health care expenses, a little over half (51%) were for ambulatory care. Home health care was another significant contributor to the average total health expenditures of children with treated ASD, representing 35% (or $7,168) of their average total expenditures.
Regardless of the cause, payers and health plan executives are going to be looking for solutions for improving the health outcomes of consumers with autism—and reducing their total cost of care. This is an opportunity for innovative provider organizations.Â