Objectives: To examine the extent of utilization of health services by children diagnosed with PDD in Israel, and to analyze the factors that are associated with different utilization patterns.
Methods: A survey of children aged 4-10 years, with a diagnosis of PDD, who visited the child development center at the Sheba Medical Center. Data collection was based on a semi-structured telephone interview with the parents of the children. The main dependent variables were out-of-pocket expenditures for health services and hours of therapy. The main independent variables were clinical and socio-demographic child and familial factors. Multivariable logistic regression models were used in order to find independent predictors for health services utilization. Costs were converted to US Dollars using conversion rate of 1 USD = 3.74 New Israeli Shekel.
Results: Parents of 204 children were contacted and were asked to participate in the study. Parents of 178 of the children (87%) agreed to participate and completed the interview (85% males, mean age 6.7 +1.9 years).
The average annual “out-of-pocket cost” was $8,288, with a median of $4,473 and a range of $0-89,754, of which 85% is spent on private providers. High severity of ASD and at least one of the parents with academic education were independently and directly associated with higher out-of-pocket expenditure. Having at least one older sibling, siblings without developmental disorders, regular education of the ASD child, lower parent education and low income were independently associated with being at the lower expenditure.
The average weekly hours of therapy was 7.3 (SD: 5.25), with a median of 6.0 hours and a range of 1.0 - 34.3. The only variable which was independently associated with very low number of services was full integration within regular educational frameworks, especially at school age. The variables that were found to be independently associated with getting very high amount of services: being a child to ultra-orthodox parents, income above average and high severity of ASD.
Conclusions: Children with ASD in Israel are receiving services mainly according to socio-demographic characteristics of their parents. This is related to the fact that most services required by families are not reimbursed by the national basket of services. Children of parents who are ultra-orthodox, have low income or low education level, immigrants, and children who are not firstborn – tend to go to special education settings, which include much more services at lower “out of pocket” costs. Parents with higher education and income level tend to integrate their children into regular settings, and consume services from private providers.