tag:blogger.com,1999:blog-7476621888383604834.post4887187897392827304..comments2024-02-15T03:26:38.897-05:00Comments on Health Care Organizational Ethics: Should Health Insurance Cover Services for Autism - an Ethical AnalysisJim Sabinhttp://www.blogger.com/profile/03087828142188534542noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-7476621888383604834.post-37627248134353426202008-10-04T09:19:00.000-04:002008-10-04T09:19:00.000-04:00Hello Eric -Your question about what makes a "trea...Hello Eric -<BR/><BR/>Your question about what makes a "treatment" a "treatment" is important. Health insurance typically contrasts "treatment" to "custodial care." The distinction is most difficult to make when the activities that constitute the treatment are on a continuum with activities of ordinary life, as with psychotherapy and physical therapy. <BR/><BR/>One distinguishing feature is whether professional skills are required to conduct the activity. If what was required to foster the targeted functional improvements for a child with autism was good parenting, we would not expect health insurance to pay. I know from psychologist colleagues that they often consult to families to help parents develop a program of care. Their professional time might be covered by health insurance. The parents' time wouldn't - not because it isn't difficult, demanding and health promoting, but because society has largely chosen not to pay parents for carrying out parental functions.<BR/><BR/>Your question has been battled over again and again with regard to psychotherapy. It's complicated. Norman Daniels and I wrote about this in the 1994 Nov/Dec Hastings Center Report -"Determining 'Medical Necessity' in Mental Health Practice." Woody Allen's old films made psychotherapy into a joke - with the Allen character whining endlessly about his troubled love life.<BR/><BR/>The practical controversy for autism I touched on in this post is deciding who should pay for programs that have characteristics of preschool or school, but also have characteristics of hospital-like behavioral interventions - families (when they can), the educational sector, or the health sector. My view is that the services most closely resemble special education and, if adequately funded without undermining "regular education," would thrive best in the education sector.<BR/><BR/>Thanks for your very thoughtful comments!<BR/><BR/>Best<BR/><BR/>JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-40876500877673816572008-10-03T20:58:00.000-04:002008-10-03T20:58:00.000-04:00What makes a treatment a treatment? What differen...What makes a treatment a treatment? What differentiates it from a supportive home, creative and adaptable parents? If a parent gave up their job to stay home with the autistic child, would that yield the same results as the "treatment?" If it did yield the same results as the treatment, should we pay the parent to stay home? If the parent demanded payment from society for taking care of their child in the style to which they are accustomed (mcmansion and porsche), should we pay for it?<BR/>Helen Keller's parents could afford an Annie Sullivan. But the parents of my retarded patient could not, nor could the daughter of my stroke patient. Yet these parents and this daughter have taken beautiful care of their loved ones, with little public assistance, and great personal sacrifice.erichttps://www.blogger.com/profile/16137189911651175163noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-38843442539453821902008-09-23T14:03:00.000-04:002008-09-23T14:03:00.000-04:00Dear Autism Reality -Thank you for this informativ...Dear Autism Reality -<BR/><BR/>Thank you for this informative post.<BR/><BR/>The studies and reports you cite are just the kind of material that is needed for informed deliberation about health benefits, whether in the U.S. system of competing insurers or a European system of universal coverage. <BR/><BR/>I am not an expert on autism research, but my expectation from experience in psychiatry is that a focused behavioral program like ABA will indeed be seen as effective over time. When effectiveness is agreed upon, policy makers will have to decide what is part of society's obligation to provide educational services and what is part of society's obligation to provide health or medical services.<BR/><BR/>It could be that the behavioral services themselves would be best served by being part of a comprehensive education and socialization program. But the health sector is often a more promising place to look for funding, given that we do not have budgets for health care the way we do for education.<BR/><BR/>Best<BR/><BR/>JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-87044262438302435102008-09-23T06:05:00.000-04:002008-09-23T06:05:00.000-04:00Behavioral treatments have already been shown to p...Behavioral treatments have already been shown to provide significant improvements for autism as last reported by the American Academy of Pediatrics Management of Children With Autism Spectrum Disorders (October 29, 2007)<BR/><BR/> Management of ABA methods are used to increase and maintain desirable adaptive behaviors,reduce interfering maladaptive behaviors or narrow<BR/>the conditions under which they occur, teach new skills, and generalize behaviors to new environments or situations. ABA focuses on the reliable measurement and objective evaluation of observable behavior within relevant settings including the home, school, and community.<BR/><BR/>The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of<BR/>research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive<BR/>behavioral intervention programs in university and community settings.29–40 Children who receive early intensive<BR/>behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–40<BR/><BR/>Reviews by the NYSDOH (2005), the MADSEC (Maine) Autism Task Force Report (2000) and the Office of the US Surgeon General (1997) reached similar conclusions about the effectiveness of ABA as an autism treatment.Anonymoushttps://www.blogger.com/profile/05838571980003579163noreply@blogger.com