Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

High-deductible plans do not raise out-of-pocket costs for autism care

Key clinical point: Families in high-deductible health plans don’t pay more out-of-pocket expenses than those in traditional plans in states that mandate autism services coverage.

Major finding: Autism spectrum disorder coverage mandates were linked to a $142 greater increase in average monthly spending for insurers on all health services, however, out-of-pocket spending by patients was not significantly different between high-deductible health plans and traditional plan enrollees,

Study details: An analysis of insurance claims for 98,639 children covered by three large U.S. insurers between 2008 and 2012.

Disclosures: The authors reported no relevant financial disclosures. The study was supported by a National Institute of Mental Health grant and funded by the National Institutes of Health.


Barry CL et al. Pediatrics. 2019 May 13. doi: 10.1542/peds.2018-2391.


The analysis by Barry et al. takes a deep dive into the impact of different payment models on a family’s access to autism spectrum disorder–related services, commented David Keller, MD, and Ann Reynolds, MD.

The work emphasizes the reason that “we must continue to study how interventions in behavioral economics, such as mandates and high-deductible health plans, impact access to care for our most vulnerable children,” they wrote.

These data were from 2008 to 2012, before the Affordable Care Act was implemented. As the definition of “high deductible” has changed from $3,000 annually to $10,000 annually, “have families made different choices regarding care?” they asked.

“With the implementation of value-based payments, we will be creating competing forces through the application of behavioral economics. We need to understand how the interplay of economic forces affects families and their access to essential services,” Dr. Keller and Dr. Reynolds continued.

“We need to understand how to help families make informed decisions that balance the needs of their children with the financial realities of our complex care system so that we can support them in that process,” they wrote. “Understanding the impact of behavioral economics on consumer behavior is essential to assuring that children get the right care at the right time for the right diagnosis.”

Dr. Keller is a professor and Dr. Reynolds is an associate professor at the University of Colorado at Denver, Aurora. This is an excerpt of their editorial that accompanies the study by Barry et al. (Pediatrics. 2019 May 13. doi: 10.1542/peds.2019-0926). Dr. Keller reported no relevant financial disclosures. Dr. Reynolds reported providing consultation to Ovid Therapeutics regarding evaluation of sleep severity and improvement in clinical trials.