Healthcare access and services use among US children with autism spectrum disorder

This study aimed to determine associations of healthcare access problems with services use among US children with autism spectrum disorder. We analyzed 2011-2014 National Health Interview Survey data on 651 children with autism spectrum disorder aged 2-17 years. There were three measures of healthcare access problems: (1) delays accessing healthcare, (2) difficulty affording healthcare, and (3) trouble finding a primary care provider. There were five service use measures: (1) > 4 office visits, (2) > 1 well-child visit, (3) flu vaccine, (4) prescription medication, and (5) > 1 emergency department visit. Multivariable regression models estimated associations of > 1 healthcare access problem with each service use variable and effect modification by socioeconomic status and race and ethnicity. Twenty-nine percent of children with autism spectrum disorder had > 1 healthcare access problem. Having > 1 healthcare access problem was associated with lower adjusted odds of > 1 well-child visit or prescription medication use but higher adjusted odds of > 4 office visits or > 1 emergency department visit. No significant association was found for flu vaccine. Associations of healthcare access problems with emergency department use were most pronounced for higher socioeconomic status and White, non-Hispanic subgroups. Intervention, such as insurance expansion, is needed to improve healthcare access for children with autism spectrum disorder.