Outpatient visits and expenditures for children and adolescents diagnosed with autism spectrum disorders and co-occurring intellectual disability: An analysis of the national health insurance claims data

The primary healthcare service profile is important and provides valuable information on healthcare policies for patients with autism spectrum disorders (ASD) and co-occurring conditions. The present study analyzed data associated with outpatient care visits and expenditures in patients with ASD and co-occurring intellectual disability (ID) using healthcare setting insurance claims data in Taiwan. A retrospective analysis was conducted by merging database of healthcare setting medical care discharge claims used by the Taiwan Bureau of National Health Insurance and Disability Registration System. There were 5273 children and adolescents with ASD who utilized outpatient services during the year 2005. Taiwan NHI claims (510 cases with co-occurring ID and 4763 cases without ID) were analyzed in the study. The study found that ASD subjects without ID have 1.6-fold the annual outpatient visits of those with ID (13 visits vs. 8 visits). Those ASD cases with ID are more likely to use psychiatric visits and that individuals without ID use more rehabilitation services. The total annual outpatient care expenditure from 5273 children and adolescents with ASD was 137,842,159 New Taiwan Dollars (NTD). Cases without ID have increased medical costs compared with cases with ID in annual outpatient care expenditure (OR = 1.274, 95% CI = 1.173-1.384). A logistic regression analysis of outpatient expenditure (low vs. high) showed that of the cases with ASD and ID, the factors of age (reference: 6-11 years; 0-5 years, OR = 1.383, 95% CI = 1.106-1.730), severe illness (reference: no; OR = 1.838, 95% CI = 1.538-2.196), low income family (reference: no; OR = 1.799, 95% CI = 1.344-2.408), medical care setting (reference: clinic; private hospital: OR = 1.769, 95% CI = 1.199-2.610; corporate hospital, OR = 1.624, 95% CI = 1.139-2.315) and clinical unit (reference: psychiatric; rehabilitation, OR = 1.913, 95% CI = 1.651-2.344; pediatrics, OR = 1.461, 95% CI = 1.014-2.017) had more outpatient costs (on average) than their counterparts. Finally, this study highlights that health authorities should pay much attention to the factors which correlated to medical needs and costs of children and adolescents with ASD and ID to ensure efficacy of medication and continuing support for patients in treatment.