Type of health insurance and the substance abuse treatment gap

Bouchery, Ellen; Harwood, Henrick J.; Dilonardo, Joan; Vandivort-Warren, Rita

doi:10.1016/j.jsat.2011.09.002

Cited by 25 publications

(11 citation statements)

References 40 publications

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“…Of those 11 percent, only one in five recipients received any treatment, and only one in seven received treatment from a specialty provider. 23 Although most mental health providers are certified for Medicaid participation, a smaller percentage of substance abuse treatment providers are similarly certified. 24 A substance use treatment provider may not participate in Medicaid because its staff might not be able to meet the Medicaid licensure requirements and the facility may not meet state certification requirements for designated facilities.…”

Section: Study Resultsmentioning

confidence: 99%

“…Of those people, only one in fourteen received any treatment, and only one in twenty-five received treatment from a specialty provider. 23 The distribution of spending on substance use disorders by provider type suggests that the proportion of treatment delivered in specialty substance abuse centers is declining. These centers continued to receive the largest share of treatment spending in 2009 (35 percent), but that share was less than the 44 percent of spending they received in 2004 (Exhibit 4).…”

Section: Study Resultsmentioning

confidence: 99%

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Federal Spending On Behavioral Health Accelerated During Recession As Individuals Lost Employer Insurance

et al. 2013

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The 2007-09 recession had a dramatic effect on behavioral health spending, with the effect most prominent for private, state, and local payers. During the recession behavioral health spending increased at a 4.6 percent average annual rate, down from 6.1 percent in 2004-07. Average annual growth in private behavioral health spending during the recession slowed to 2.7 percent from 7.2 percent in 2004-07. State and local behavioral health spending showed negative average annual growth, -1.2 percent, during the recession, compared with 3.7 percent increases in 2004-07. In contrast, federal behavioral health spending growth accelerated to 11.1 percent during the recession, up from 7.2 percent in 2004-07. These behavioral health spending trends were driven largely by increased federal spending in Medicaid, declining private insurance enrollment, and severe state budget constraints. An increased federal Medicaid match reduced the state share of Medicaid spending, which prevented more drastic cuts in state-funded behavioral health programs during the recession. Federal Medicaid served as a critical safety net for people with behavioral health treatment needs during the recession.

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Section: Study Resultsmentioning

confidence: 99%

Section: Study Resultsmentioning

confidence: 99%

Federal Spending On Behavioral Health Accelerated During Recession As Individuals Lost Employer Insurance

et al. 2013

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“…(15, 30, 31) Our covariates comprised the percentage of state population who are (a) Black/African Americans, (b) Hispanic/Latino Americans, (c) living in poverty (≤ 100% FPL), (d) classified with SUD, 2 and (e) eligible for Medicaid. We also included the per capita amount of the Substance Abuse Prevention and Treatment Block Grant (SAPTBG) allocated to the state as a proxy for system capacity.…”

Section: Methodsmentioning

confidence: 99%

“…(1, 15) Ever since the inception of third-party payment for SUD treatment, coverage for SUD treatment has been more restrictive than that for medical/surgical treatment in terms of cost sharing and treatment limitations. (16–18) To address these discriminatory restrictions, more than one-half of states in the U.S. have enacted SUD parity laws during the past two decades requiring employment-related group health plans to provide coverage for SUD treatment equal to that for comparable medical/surgical treatment.…”

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confidence: 99%

State Parity Laws and Access to Treatment for Substance Use Disorder in the United States

et al. 2013

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“…In the US, fewer than 20% of individuals with drug use disorders and 10% with alcohol use disorders receive treatment (4). In the U.S., SUD is often undetected and goes untreated in primary care settings, and likewise, medical care needs of individuals with SUD are not properly addressed in the specialty SUD treatment sector (5). This is due in large part to the ongoing separation of the delivery and financing of SUD treatment from the rest of the medical system in the US.…”

Section: Introductionmentioning

confidence: 99%

Effects of accountable care and payment reform on substance use disorder treatment: evidence from the initial 3 years of the alternative quality contract

et al. 2016

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Background and Aims Global payment and accountable care reform efforts in the US may connect more individuals with substance use disorders (SUD) to treatment. We tested whether such changes instituted under an ‘Alternative Quality Contract’ (AQC) model within the Blue Cross Blue Shield of Massachusetts’ (BCBSMA) insurer increased care for individuals with SUD. Design Difference-in-differences design comparing enrollees in AQC organizations with a comparison group of enrollees in organizations not participating in the AQC. Setting Massachusetts, USA. Participants BCBSMA enrollees aged 13–64 from 2006–2011 (three years prior to and after implementation) representing 1,333,534 enrollees and 42,801 SUD service users. Measurements Outcomes were SUD service use and spending and SUD performance metrics. Primary exposures were enrollment in an AQC provider organization and whether the AQC organization did or did not face risk for behavioral health costs. Findings Enrollees in AQC organizations facing behavioral health risk experienced no change in the probability of using SUD services (1.64% vs. 1.66%; p=0.63), SUD spending ($2,807 vs. $2,700; p=0.34) or total spending ($12,631 vs. $12,849; p=0.53), or SUD performance metrics (identification: 1.73% vs. 1.76%, p=0.57; initiation: 27.86% vs. 27.02%, p=0.50; engagement: 11.19% vs. 10.97%, p=0.79). Enrollees in AQC organizations not at risk for behavioral health spending experienced a small increase in the probability of using SUD services (1.83% vs. 1.66%; p=0.003) and the identification performance metric (1.92% vs. 1.76%; p=0.007), and a reduction in SUD medication use (11.84% vs. 14.03%; p=0.03) and the initiation performance metric (23.76% vs. 27.02%; p=0.005). Conclusions A global payment and accountable care model introduced in Massachusetts USA (in which a health insurer provided care providers with fixed prepayments to cover most or all of their patients’ care during a specified time period, incentivizing providers to keep their patients’ healthy and reduce costs) did not lead to sizable changes in substance use disorder service use during the first three years following its implementation.

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Type of health insurance and the substance abuse treatment gap

Cited by 25 publications

References 40 publications

Federal Spending On Behavioral Health Accelerated During Recession As Individuals Lost Employer Insurance

Federal Spending On Behavioral Health Accelerated During Recession As Individuals Lost Employer Insurance

State Parity Laws and Access to Treatment for Substance Use Disorder in the United States

Effects of accountable care and payment reform on substance use disorder treatment: evidence from the initial 3 years of the alternative quality contract

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