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Lazic A, Tilford JM, Davis VP, Brown CC. Association of copayments with healthcare utilization and expenditures among Medicaid enrollees with a substance use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209314. [PMID: 38369244 PMCID: PMC11090739 DOI: 10.1016/j.josat.2024.209314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/04/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The purpose of this study was to examine the association between copayments and healthcare utilization and expenditures among Medicaid enrollees with substance use disorders. METHODS This study used claims data (2020-2021) from a private insurer participating in Arkansas's Medicaid expansion. We compared service utilization and expenditures for enrollees in different Medicaid program structures with varying copayments. Enrollees with incomes above 100 % FPL (N = 10,240) had copayments for substance use treatment services while enrollees below 100 % FPL (N = 2478) did not. Demographic, diagnostic, utilization, and cost information came from claims and enrollment information. The study identified substance use and clinical comorbidities using claims from July through December 2020 and evaluated utilization and costs in 2021. Generalized linear models (GLM) estimated outcomes using single equation and two-part modeling. A gamma distribution and log link were used to model expenditures, and negative binomial models were used to model utilization. A falsification test comparing behavioral health telemedicine utilization, which had no cost sharing in either group, assessed whether differences in the groups may be responsible for observed findings. RESULTS Substance use enrollees with copayments were less likely to have a substance use or behavioral health outpatient (-0.04 PP adjusted; p = 0.001) or inpatient visit (-0.04 PP; p = 0.001) relative to their counterparts without copayments, equal to a 17 % reduction in substance use or behavioral health outpatient services and a nearly 50 % reduction in inpatient visits. The reduced utilization among enrollees with a copayment was associated with a significant reduction in total expenses ($954; p = 0.001) and expenses related to substance use or behavioral health services ($532; p = 0.001). For enrollees with at least one behavioral health visit, there were no differences in outpatient or inpatient utilization or expenditures between enrollees with and without copayments. Copayments had no association with non-behavioral health or telemedicine services where neither group had cost sharing. CONCLUSION Copayments serve as an initial barrier to substance use treatment, but are not associated with the amount of healthcare utilization conditional on using services. Policy makers and insurers should consider the role of copayments for treatment services among enrollees with substance use disorders in Medicaid programs.
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Affiliation(s)
- Antonije Lazic
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA
| | - J Mick Tilford
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA
| | - Victor P Davis
- Actuarial Services & Enterprise Underwriting, Arkansas Blue Cross Blue Shield, Little Rock, AR 72201, USA
| | - Clare C Brown
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA.
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Douglas MD, Bent Weber S, Bass C, Li C, Gaglioti AH, Benevides T, Heboyan V. Creation of a Longitudinal Legal Data Set to Support Legal Epidemiology Studies of Mental Health Insurance Legislation. Psychiatr Serv 2022; 73:265-270. [PMID: 34320828 DOI: 10.1176/appi.ps.202100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This article describes policy surveillance methodology used to track changes in the comprehensiveness of state mental health insurance laws over 23 years, resulting in a data set that supports legal epidemiology studies measuring effects of these laws on mental health outcomes. METHODS Structured policy surveillance methods, including a coding protocol, blind coding of laws in 10% of states, and consensus meetings, were used to track changes in state laws from 1997 through 2019-2020. The legal database Westlaw was used to identify relevant statutes. The legal coding instrument included six questions across four themes: parity, mandated coverage, definitions of mental health conditions, and enforcement-compliance. Points (range 0-7) were assigned to reflect the laws' comprehensiveness and aid interpretation of changes over time. RESULTS The search resulted in 147 coding time periods across 51 jurisdictions (50 states, District of Columbia). Intercoder consensus rates increased from 89% to 100% in the final round of blinded duplicate coding. Since 1997, average comprehensiveness scores increased from 1.31 to 3.82. In 1997, 41% of jurisdictions had a parity law, 28% mandated coverage, 31% defined mental health conditions, and 8% required state agency enforcement. In 2019-2020, 94% of jurisdictions had a parity law, 63% mandated coverage, 75% defined mental health conditions, and 29% required state enforcement efforts. CONCLUSIONS Comprehensiveness of state mental health insurance laws increased from 1997 through 2019-2020. The State Mental Health Insurance Laws Dataset will enable evaluation research on effects of comprehensive legislation and cumulative impact.
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Affiliation(s)
- Megan D Douglas
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Samantha Bent Weber
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Claire Bass
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Chaohua Li
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Anne H Gaglioti
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Teal Benevides
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
| | - Vahé Heboyan
- National Center for Primary Care (Douglas, Li, Gaglioti), Department of Community Health and Preventive Medicine (Douglas), Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta; Legal Consultant, Atlanta (Bent Weber); College of Law, Georgia State University, Atlanta (Bass); Department of Occupational Therapy, College of Allied Health Sciences (Benevides), Institute of Public and Preventive Health (Benevides), Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia (Heboyan), Augusta University, Augusta, Georgia
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Mulia N, Lui CK, Bensley KM, Subbaraman MS. Effects of Medicaid expansion on alcohol and opioid treatment admissions in U.S. racial/ethnic groups. Drug Alcohol Depend 2022; 231:109242. [PMID: 35007958 PMCID: PMC9009866 DOI: 10.1016/j.drugalcdep.2021.109242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/29/2021] [Accepted: 11/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Excessive drinking and opioid misuse exact a high toll on U.S. lives and differentially affect U.S. racial/ethnic groups in exposure and resultant harms. Increasing access to specialty treatment is an important policy strategy to mitigate this, particularly for lower-income and racial/ethnic minority persons who face distinctive barriers to care. We examined whether the U.S. Affordable Care Act's Medicaid expansion improved treatment utilization in the overall population and for Black, Latino, and White Americans separately. METHODS We analyzed total and Medicaid-insured alcohol and opioid treatment admissions per 10,000 adult, state residents using 2010-2016 data from SAMHSA's Treatment Episode Data Set (N = 20 states), with difference-in-difference models accounting for state fixed effects and time-varying state demographic characteristics, treatment need, and treatment supply. RESULTS Total treatment admission rates in the overall population declined for alcohol and remained roughly flat for opioids in both expansion and non-expansion states from 2010 through 2016. By contrast, estimated Medicaid-insured alcohol and opioid treatment rates rose in expansion states and decreased in non-expansion states following Medicaid expansion in 2014. The latter results were found for alcohol treatment in the total population and in each racial/ethnic group, as well as for Black and White Americans for opioid treatment. CONCLUSIONS Medicaid expansion was associated with greater specialty treatment entry at a time when alcohol and opioid treatment rates were declining or flat. Findings underscore benefits of expanding Medicaid eligibility to increase treatment utilization for diverse racial/ethnic groups, but also suggest an emerging treatment disparity between lower-income Americans in expansion and non-expansion states.
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Affiliation(s)
- Nina Mulia
- Alcohol Research Group, 6001 Shellmound St., Suite 405, Emeryville, CA 94608, USA.
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Heboyan V, Douglas MD, McGregor B, Benevides TW. Impact of Mental Health Insurance Legislation on Mental Health Treatment in a Longitudinal Sample of Adolescents. Med Care 2021; 59:939-946. [PMID: 34369459 PMCID: PMC8425633 DOI: 10.1097/mlr.0000000000001619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mental health insurance laws are intended to improve access to needed treatments and prevent discrimination in coverage for mental health conditions and other medical conditions. OBJECTIVES The aim was to estimate the impact of these policies on mental health treatment utilization in a nationally representative longitudinal sample of youth followed through adulthood. METHODS We used data from the 1997 National Longitudinal Survey of Youth and the Mental Health Insurance Laws data set. We specified a zero-inflated negative binomial regression model to estimate the relationship between mental health treatment utilization and law exposure while controlling for other explanatory variables. RESULTS We found that the number of mental health treatment visits declined as cumulative exposure to mental health insurance legislation increased; a 10 unit (or 10.3%) increase in the law exposure strength resulted in a 4% decline in the number of mental health visits. We also found that state mental health insurance laws are associated with reducing mental health treatments and disparities within at-risk subgroups. CONCLUSIONS Prolonged exposure to comprehensive mental health laws across a person's childhood and adolescence may reduce the demand for mental health visitations in adulthood, hence, reducing the burden on the payors and consumers. Further, as the exposure to the mental health law strengthened, the gap between at-risk subgroups was narrowed or eliminated at the highest policy exposure levels.
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Affiliation(s)
- Vahé Heboyan
- Department of Population Health Sciences, Health Economics and Modeling Division, Medical College of Georgia, Augusta University, Augusta
| | - Megan D. Douglas
- Department of Community Health and Preventive Medicine, National Center for Primary Care
- Kennedy-Satcher Center for Mental Health Equity, Morehouse School of Medicine
| | | | - Teal W. Benevides
- Department of Occupational Therapy, College of Allied Health Sciences
- Institute of Public and Preventive Health, Augusta University, Augusta, GA
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Grooms J, Ortega A. Substance use disorders among older populations: What role do race and ethnicity play in treatment and completion? J Subst Abuse Treat 2021; 132:108443. [PMID: 34102462 DOI: 10.1016/j.jsat.2021.108443] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/19/2022]
Abstract
Research that explores the role of substance use treatment among older individuals is scarce. This paper offers a historical investigation of admissions and discharges for treatment episodes over the past two decades across race, ethnicity, gender, and age. Our results suggest that although older individuals are not typically associated with risky behavior, they are increasingly seeking treatment for substance use disorders. We find that substance use treatment admissions for people aged 50 and older have persistently increased over our sample period. Our findings also indicate that, on average, Black (relative to white) admissions across all ages are less likely to complete treatment and more likely to have their treatment terminated by a treatment facility. We also find some evidence that Hispanic admissions are relatively less likely to complete treatment across all age groups. Hispanics over 50 years old are also more likely to terminate treatment. Interestingly, among younger individuals in the most recent years of our sample, the disparity between minority completion rates has improved. Lastly, we find that males (relative to females) are more likely to complete a substance use treatment program but no more likely to have their treatment terminated by a substance use treatment facility.
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Hamersma S, Maclean JC. Insurance expansions and adolescent use of substance use disorder treatment. Health Serv Res 2021; 56:256-267. [PMID: 33210305 PMCID: PMC7969204 DOI: 10.1111/1475-6773.13604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To provide evidence on the effects of expansions to private and public insurance programs on adolescent specialty substance use disorder (SUD) treatment use. DATA SOURCE/STUDY SETTING The Treatment Episodes Data Set (TEDS), 1996 to 2017. STUDY DESIGN A quasi-experimental difference-in-differences design using observational data. DATA COLLECTION The TEDS provides administrative data on admissions to specialty SUD treatment. PRINCIPAL FINDINGS Expansions of laws that compel private insurers to cover SUD treatment services at parity with general health care increase adolescent admissions by 26% (P < .05). These increases are driven by nonintensive outpatient admissions, the most common treatment episodes, which rise by 30% (P < .05) postparity law. In contrast, increases in income eligibility for public insurance targeting those 6-18 years old are not statistically associated with SUD treatment. CONCLUSIONS Private insurance expansions allow more adolescents to receive SUD treatment, while public insurance income eligibility expansions do not appear to influence adolescent SUD treatment.
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Affiliation(s)
- Sarah Hamersma
- Department of Public Administration and International AffairsSyracuse UniversitySyracuseNew YorkUSA
- Center for Policy ResearchSyracuseNew YorkUSA
| | - Johanna Catherine Maclean
- Department of EconomicsTemple UniversityPhiladelphiaPennsylvaniaUSA
- National Bureau of Economic ResearchCambridgeMassachusettsUSA
- Institute for the Study of LaborBonnGermany
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Hamersma S, Maclean JC. Do expansions in adolescent access to public insurance affect the decisions of substance use disorder treatment providers? JOURNAL OF HEALTH ECONOMICS 2021; 76:102434. [PMID: 33578327 DOI: 10.1016/j.jhealeco.2021.102434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
We apply a mixed-payer economy model to study the effects of changes in the generosity of children's public health insurance programs - measured by Medicaid and Children's Health Insurance Program income thresholds - on substance use disorder (SUD) treatment provider behavior. Using government data on specialty SUD treatment providers over the period 1997-2011 combined with a two-way fixed-effects model and local event study, we show that increases in the generosity of children's public health insurance induce providers to participate in some, but not all, public markets. Our effects appear to be driven by non-profit and government providers. Non-profit providers also appear to increase treatment quantity slightly in response to coverage expansions.
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Affiliation(s)
- Sarah Hamersma
- Department of Public Administration and International Affairs, Syracuse University, Senior Research Associate, Center for Policy Research, Syracuse, NY, USA.
| | - Johanna Catherine Maclean
- National Bureau of Economic Research, Cambridge, MA, USA; Institute for the Study of Labor, Bonn, Germany.
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Shen Y, Noguchi H. Impacts of anticancer drug parity laws on mortality rates. Soc Sci Med 2021; 272:113714. [PMID: 33545495 DOI: 10.1016/j.socscimed.2021.113714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
This study investigates the impacts of anticancer drug parity laws on mortality rates in the United States using a difference-in-differences approach. Using data from 2004 to 2017 Compressed Mortality Files, we show that the anticancer drug parity laws reduce the mortality rate for head/neck malignant cancers but have no impact on malignant cancers of other types. We also rule out an insurance expansion channel that may influence the relationship between anticancer drug parity laws and malignant cancer mortality. Our results are robust to various specifications and falsification tests. Our findings imply that providing equal access to oral anticancer drugs is an effective tool for the prevention of premature mortality.
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Affiliation(s)
- Yichen Shen
- Graduate School of Economics, Waseda University, 1-6-1 Nishi-Waseda, Shinjuku, Tokyo, 169-8050, Japan.
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University, 1-6-1 Nishi-Waseda, Shinjuku, Tokyo, 169-8050, Japan.
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Changes in Medicaid Acceptance by Substance Abuse Treatment Facilities After Implementation of Federal Parity. Med Care 2020; 58:101-107. [PMID: 31688556 DOI: 10.1097/mlr.0000000000001242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adequate access for mental illness and substance use disorder (SUD) treatment, particularly for Medicaid enrollees, is challenging. Policy efforts, including the Mental Health Parity and Addiction Equity Act (MHPAEA), have targeted expanded access to care. With MHPAEA, more Medicaid plans were required to increase their coverage of SUD treatment, which may impact provider acceptance of Medicaid. OBJECTIVES To identify changes in Medicaid acceptance by SUD treatment facilities after the implementation of MHPAEA (parity). RESEARCH DESIGN Observational study using an interrupted time series design. SUBJECTS 2002-2013 data from the National Survey of Substance Abuse Treatment Services (N-SSATS) for all SUD treatment facilities was combined with state-level characteristics. MEASURES Primary outcome is whether a SUD treatment facility reported accepting Medicaid insurance. RESULTS Implementation of MHPAEA was associated with a 4.6 percentage point increase in the probability of an SUD treatment facility accepting Medicaid (P<0.001), independent of facility and state characteristics, time trends, and key characteristics of state Medicaid programs. CONCLUSIONS After parity, more SUD treatment facilities accepted Medicaid payments, which may ultimately increase access to care for individuals with SUD. The findings underscore how parity laws are critical policy tools for creating contexts that enable historically vulnerable and underserved populations with SUD to access needed health care.
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Grecu AM, Spector LC. Nurse practitioner's independent prescriptive authority and opioids abuse. HEALTH ECONOMICS 2019; 28:1220-1225. [PMID: 31243861 DOI: 10.1002/hec.3922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 04/10/2019] [Accepted: 05/15/2019] [Indexed: 06/09/2023]
Abstract
This paper investigates the impact of legislative changes allowing nurse practitioners to prescribe schedule II controlled substances independently. We find that this legal environment is associated with an increase in treatment admissions for opioid misuse and a decrease in opioid related mortality only when Mandatory Prescription Drugs Monitoring Programs are in place.
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Affiliation(s)
- Anca M Grecu
- Department of Economics and Legal Studies, Seton Hall University, South Orange, New Jersey
| | - Lee C Spector
- Department of Economics, Ball State University, Muncie, Indiana
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Mulia N, Lui CK, Ye Y, Subbaraman MS, Kerr WC, Greenfield TK. U.S. alcohol treatment admissions after the Mental Health Parity and Addiction Equity Act: Do state parity laws and race/ethnicity make a difference? J Subst Abuse Treat 2019; 106:113-121. [PMID: 31451310 DOI: 10.1016/j.jsat.2019.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/11/2019] [Accepted: 08/10/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The U.S. Mental Health Parity and Addiction Equity Act (MHPAEA) was a landmark federal policy aimed at increasing access to substance use treatment, yet studies have found relatively weak impacts on treatment utilization. The present study considers whether there may be moderating effects of pre-existing state parity laws and differential changes in treatment rates across racial/ethnic groups. METHODS We analyzed data from SAMHSA'S Treatment Episode Data Set (TEDS) from 1999 to 2013, assessing changes in alcohol treatment admission rates across states with heterogeneous, pre-existing parity laws. NIAAA's Alcohol Policy Information System data were used to code states into five groups based on the presence and strength of states' pre-MHPAEA mandates for insurance coverage of alcohol treatment and parity (weak; coverage no parity; partial parity if coverage offered; coverage and partial parity; strong). Regression models included state fixed effects and a cubic time trend adjusting for state- and year-level covariates, and assessed MHPAEA main effects and interactions with state parity laws in the overall sample and racial/ethnic subgroups. RESULTS While we found no significant main effects of federal parity on alcohol treatment rates, there was a significantly greater increase in treatment rates in states requiring health plans to cover alcohol treatment and having some pre-existing parity. This was seen overall and in all three racial/ethnic groups (increasing by 25% in whites, 26% in blacks, and 42% in Hispanics above the expected treatment rate for these groups). Post-MHPAEA, the alcohol treatment admissions rate in these states rose to the level of states with the strongest pre-existing parity laws. CONCLUSION The MHPAEA was associated with increased alcohol treatment rates for diverse racial/ethnic groups in states with both alcohol treatment coverage mandates and some prior parity protections. This suggests the importance of the local policy context in understanding early effects of the MHPAEA.
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Affiliation(s)
- Nina Mulia
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA.
| | - Camillia K Lui
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Meenakshi S Subbaraman
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
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Grooms J, Ortega A. Examining Medicaid Expansion and the Treatment of Substance Use Disorders. ACTA ACUST UNITED AC 2019. [DOI: 10.1257/pandp.20191090] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As the drug epidemic continues to cripple communities and disrupt our country, identifying and understanding state and federal policies which have helped alleviate the burden of substance use disorders (SUDs) is imperative. In 2010, the passage of the Patient Protection and Affordable Care Act (ACA) expanded health coverage and services offered to millions of Americans. Prior to the ACA, treatment for substance use disorders was not included in all medical coverage. We examine the brief literature on ACA Medicaid Expansion and SUDs and complement this literature by including the effects on measures of supply and efficacy of SUD treatment.
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Affiliation(s)
- Jevay Grooms
- Department of Economics, Howard University, ASB-B Room 307, 2400 6th Street NW, Washington, DC 20059
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Maclean JC, Saloner B. The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2019; 38:366-393. [PMID: 30882195 DOI: 10.1002/pam.22112] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We examine the effect of Medicaid expansion under the Affordable Care Act (ACA) on substance use disorder (SUD) treatment utilization and financing. We combine data on admissions to specialty facilities and Medicaid-reimbursed prescriptions for medications commonly used to treat SUDs in nonspecialty outpatient settings with an event-study design. Several findings emerge from our study. First, among patients receiving specialty care, Medicaid coverage and payments increased. Second, the share of patients who were uninsured and who had treatment paid for by state and local government payments declined. Third, private insurance coverage and payments increased. Fourth, expansion also increased prescriptions for SUD medications reimbursed by Medicaid. Fifth, we find suggestive evidence that admissions to specialty treatment may have increased one or more years post-expansion. However, this finding is sensitive to specification and we observe differential pretrends between the treatment and comparison groups. Thus, our finding for admissions should be interpreted with caution.
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Affiliation(s)
- Johanna Catherine Maclean
- Department of Economics at Temple University, Ritter Annex 869, 1301 Cecil B Moore Avenue, Philadelphia, PA 19122
| | - Brendan Saloner
- Departments of Health Policy and Management and Mental Health at Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 344, Baltimore, MD 21205
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Coverage mandates and market dynamics: employer, insurer and patient responses to parity laws. HEALTH ECONOMICS POLICY AND LAW 2018; 15:173-195. [DOI: 10.1017/s1744133118000294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractParity in coverage for mental health services has been a longstanding policy aim at the state and federal levels and is a regulatory feature of the Affordable Care Act. Despite the importance and legislative effort involved in these policies, evaluations of their effects on patients yield mixed results. I leverage the Employee Retirement Income Security Act and unique claims-level data that includes information on employers’ self-insurance status to shed new light in this area after the implementation of two state parity laws in 2007 and federal parity a few years later. My empirics reveal evidence of strategic avoidance on behalf of insurers in both states prior to the passage of state parity, as well as positive increases in mental health care utilization after parity laws are implemented – but context matters. Policy heterogeneity across states and strategic behaviors by employers and commercial insurers substantively shape the benefits that ultimately flow to patients. Insights from this research have broad relevance to ongoing health policy debates, particularly as states retain great discretion over many health coverage decisions and as federal policy continues to evolve.
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Nathenson R, Richards MR. Do coverage mandates affect direct-to-consumer advertising for pharmaceuticals? Evidence from parity laws. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2018; 18:321-336. [PMID: 29380108 DOI: 10.1007/s10754-018-9234-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 01/03/2018] [Indexed: 06/07/2023]
Abstract
Direct-to-consumer advertising (DTCA) for prescription drugs is a relatively unique feature of the US health care system and a source of tens of billions of dollars in annual spending. It has also garnered the attention of researchers and policymakers interested in its implications for firm and consumer behavior. However, few economic studies have explored the DTCA response to public policies, especially those mandating coverage of these products. We use detailed advertising expenditure data to assess if pharmaceutical firms increase their marketing efforts after the implementation of relevant state and federal health insurance laws. We focus on mental health parity statutes and related drug therapies-a potentially ripe setting for inducing stronger consumer demand. We find no clear indication that firms expect greater value from DTCA after these regulatory changes. DTCA appears driven by other considerations (e.g., product debut); however, it remains a possibility that firms respond to these laws through other, unobserved channels (e.g., provider detailing).
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Affiliation(s)
- Robert Nathenson
- University of Pennsylvania, 3440 Market Street Suite 560, Philadelphia, PA, 19146, USA.
| | - Michael R Richards
- Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End, Suite 1275, Nashville, 37203, TN, USA
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Popovici I, Maclean JC, Hijazi B, Radakrishnan S. The effect of state laws designed to prevent nonmedical prescription opioid use on overdose deaths and treatment. HEALTH ECONOMICS 2018; 27:294-305. [PMID: 28719096 DOI: 10.1002/hec.3548] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/14/2017] [Accepted: 05/30/2017] [Indexed: 05/26/2023]
Abstract
Nonmedical use of prescription opioids has reached epidemic levels in the United States and globally. In response, federal, state, and local governments are taking actions to address substantial increases in prescription opioid addiction and its associated harms. This study examines the effect of two state laws specifically designed to curtail access to prescription opioids to nonmedical users: pain management clinic and doctor shopping laws. We use administrative data on overdose deaths and admissions to specialty substance use disorder treatment coupled with a differences-in-differences design. Our findings suggest that both pain management clinic and doctor shopping laws have the potential to reduce prescription opioid overdose deaths. Moreover, doctor shopping laws appear to reduce prescription opioid treatment admissions. As many states have adopted these laws in recent years, the full effects of the laws may not yet be realized. Future research using more postlaw passage data should reevaluate the effectiveness of these laws.
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Affiliation(s)
- Ioana Popovici
- Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Johanna Catherine Maclean
- Department of Economics, Temple University, Philadelphia, PA, USA
- National Bureau of Economic Research (NBER), Cambridge, MA, USA
- Institute for Labor Economics (IZA), Bonn, Germany
| | - Bushra Hijazi
- Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University, Fort Lauderdale, FL, USA
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Peterson E, Busch S. Achieving Mental Health and Substance Use Disorder Treatment Parity: A Quarter Century of Policy Making and Research. Annu Rev Public Health 2018; 39:421-435. [PMID: 29328871 DOI: 10.1146/annurev-publhealth-040617-013603] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 changed the landscape of mental health and substance use disorder coverage in the United States. The MHPAEA's comprehensiveness compared with past parity laws, including its extension of parity to plan management strategies, the so-called nonquantitative treatment limitations (NQTL), led to significant improvements in mental health care coverage. In this article, we review the history of this landmark legislation and its recent expansions to new populations, describe past research on the effects of this and other mental health/substance use disorder parity laws, and describe some directions for future research, including NQTL compliance issues, effects of parity on individuals with severe mental illness, and measurement of benefits other than mental health care use.
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Affiliation(s)
- Emma Peterson
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut 06520-8034, USA; ,
| | - Susan Busch
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut 06520-8034, USA; ,
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Maclean JC, Saloner B. Substance Use Treatment Provider Behavior and Healthcare Reform: Evidence from Massachusetts. HEALTH ECONOMICS 2018; 27:76-101. [PMID: 28224675 DOI: 10.1002/hec.3484] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/31/2016] [Accepted: 12/15/2016] [Indexed: 06/06/2023]
Abstract
We examine the impact of the 2006 Massachusetts healthcare reform on substance use disorder (SUD) treatment facilities' provision of care. We test the impact of the reform on treatment quantity and access. We couple data on the near universe of specialty SUD treatment providers in the USA with a synthetic control method approach. We find little evidence that the reform lead to changes in treatment quantity or access. Reform effects were similar among for-profit and non-profit facilities. In an extension, we show that the reform altered the setting in which treatment is received, the number of offered services, and the number of programs for special populations. These findings may be useful in predicting the implications of major health insurance expansions on the provision of SUD treatment. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Johanna Catherine Maclean
- Department of Economics, Temple University, Philadelphia, PA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
- Institute of Labor Economics (IZA), Bonn, North Rhine-Westphalia, Germany
| | - Brendan Saloner
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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19
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Saloner B, Akosa Antwi Y, Maclean JC, Cook B. Access to Health Insurance and Utilization of Substance Use Disorder Treatment: Evidence from the Affordable Care Act Dependent Coverage Provision. HEALTH ECONOMICS 2018; 27:50-75. [PMID: 28127822 DOI: 10.1002/hec.3482] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/03/2016] [Accepted: 12/15/2016] [Indexed: 05/26/2023]
Abstract
The relationship between insurance coverage and use of specialty substance use disorder (SUD) treatment is not well understood. In this study, we add to the literature by examining changes in admissions to SUD treatment following the implementation of a 2010 Affordable Care Act provision requiring health insurers to offer dependent coverage to young adult children of their beneficiaries under age 26. We use national administrative data on admissions to specialty SUD treatment and apply a difference-in-differences design to study effects of the expansion on the rate of treatment utilization among young adults and, among those in treatment, changes in insurance status and payment source. We find that admissions to treatment declined by 11% after the expansion. However, the share of young adults covered by private insurance increased by 5.4 percentage points and the share with private insurance as the payment source increased by 3.7 percentage points. This increase was largely offset by decreased payment from government sources. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Johanna Catherine Maclean
- Temple University, Department of Economics, Philadelphia, PA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
- Institute for the Study of Labor, Bonn, Germany
| | - Benjamin Cook
- Harvard Medical School, Department of Psychiatry, Cambridge, MA, USA
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Li X, Ye J. The spillover effects of health insurance benefit mandates on public insurance coverage: Evidence from veterans. JOURNAL OF HEALTH ECONOMICS 2017; 55:45-60. [PMID: 28655489 DOI: 10.1016/j.jhealeco.2017.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 05/09/2017] [Accepted: 06/11/2017] [Indexed: 06/07/2023]
Abstract
This study examines how regulations in private health insurance markets affect coverage of public insurance. We focus on mental health parity laws, which mandate private health insurance to provide equal coverage for mental and physical health services. The implementation of mental health parity laws may improve a quality dimension of private health insurance but at increased costs. We graphically develop a conceptual framework and then empirically examine whether the regulations shift individuals from private to public insurance. We exploit state-by-year variation in policy implementation in 1999-2008 and focus on a sample of veterans, who have better access to public insurance than non-veterans. Using data from the Current Population Survey, we find that the parity laws reduce employer-sponsored insurance (ESI) coverage by 2.1% points. The drop in ESI is largely offset by enrollment gains in public insurance, namely through the Veterans Affairs (VA) benefit and Medicaid/Medicare programs.
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Affiliation(s)
- Xiaoxue Li
- Department of Economics, University of New Mexico, United States
| | - Jinqi Ye
- School of Economics, Huazhong University of Science and Technology, 1037 Luoyu Road, Wuhan 430074, China.
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Cantor J, Stoller KB, Saloner B. The response of substance use disorder treatment providers to changes in macroeconomic conditions. J Subst Abuse Treat 2017; 81:59-65. [PMID: 28847456 DOI: 10.1016/j.jsat.2017.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study how substance use disorder (SUD) treatment providers respond to changes in economic conditions. DATA SOURCES 2000-2012 National Survey of Substance Abuse Treatment Services (N-SSATS) which contains detailed information on specialty SUD facilities in the United States. STUDY DESIGN We use fixed-effects regression to study how changes in economic conditions, proxied by state unemployment rates, impact treatment setting, accepted payment forms, charity care, offered services, special programs, and use of pharmacotherapies by specialty SUD treatment providers. DATA COLLECTION Secondary data analysis in the N-SSATS. PRINCIPAL FINDINGS Our findings suggest a one percentage point increase in the state unemployment rate is associated with a 2.5% reduction in outpatient clients by non-profit providers and a 1.8% increase in the acceptance of private insurance as a form of payment overall. We find no evidence that inpatient treatment, the provision of charity care, offered services, or special programs are impacted by changes in the state unemployment rate. However, a one percentage point increase in the state unemployment rate leads to a 2.5% increase in the probability that a provider uses pharmacotherapies to treat addiction. CONCLUSIONS Deteriorating economic conditions may increase financial pressures on treatment providers, prompting them to seek new sources of revenue or to change their care delivery models.
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Affiliation(s)
- Jonathan Cantor
- Robert F. Wagner Graduate School of Public Service, New York University, 295 Lafayette St, New York, NY 10012, USA.
| | - Kenneth B Stoller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 911 North Broadway, Baltimore, MD 21205, USA.
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 344, Baltimore, MD 21205, USA.
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Wu LT, Zhu H, Swartz MS. Treatment utilization among persons with opioid use disorder in the United States. Drug Alcohol Depend 2016; 169:117-127. [PMID: 27810654 PMCID: PMC5223737 DOI: 10.1016/j.drugalcdep.2016.10.015] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/21/2016] [Accepted: 10/01/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The United States is experiencing an opioid overdose epidemic. Treatment use data from diverse racial/ethnic groups with opioid use disorder (OUD) are needed to inform treatment expansion efforts. METHODS We examined demographic characteristics and behavioral health of persons aged ≥12 years that met criteria for past-year OUD (n=6,125) in the 2005-2013 National Surveys on Drug Use and Health (N=503,101). We determined the prevalence and correlates of past-year use of alcohol/drug use treatment and opioid-specific treatment to inform efforts for improving OUD treatment. RESULTS Among persons with OUD, 81.93% had prescription (Rx) OUD only, 9.75% had heroin use disorder (HUD) only, and 8.32% had Rx OUD+HUD. Persons with Rx OUD+HUD tended to be white, adults aged 18-49, males, or uninsured. The majority (80.09%) of persons with OUD had another substance use disorder (SUD), and major depressive episode (MDE) was common (28.74%). Of persons with OUD, 26.19% used any alcohol or drug use treatment, and 19.44% used opioid-specific treatment. Adolescents, the uninsured, blacks, native-Hawaiians/Pacific-Islanders/Asian-Americans, persons with Rx OUD only, and persons without MDE or SUD particularly underutilized opioid-specific treatment. Among alcohol/drug use treatment users, self-help group and outpatient rehabilitation treatment were commonly used services. CONCLUSIONS Most people with OUD report no use of OUD treatment. Multifaceted interventions, including efforts to access insurance coverage, are required to change attitudes and knowledge towards addiction treatment in order to develop a supportive culture and infrastructure to enable treatment-seeking. Outreach efforts could target adolescents, minority groups, and the uninsured to improve access to treatment.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
| | - He Zhu
- Department of Psychiatry and Behavioral Sciences, Duke University
Medical Center, Durham, NC, USA
| | - Marvin S. Swartz
- Department of Psychiatry and Behavioral Sciences, Duke University
Medical Center, Durham, NC, USA
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23
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Chalmers J, Ritter A, Berends L. Estimating met demand for alcohol and other drug treatment in Australia. Addiction 2016; 111:2041-2049. [PMID: 27247161 DOI: 10.1111/add.13473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/28/2016] [Accepted: 05/20/2016] [Indexed: 11/28/2022]
Abstract
AIMS To estimate the amount of alcohol and other drug (AOD) treatment provided and number of treatment recipients in Australia in 2011-12, and document an approach for future estimates internationally. DESIGN We combined multiple data sources to estimate the amount of treatment received: administrative data on AOD treatment funded by the Australian and state/territory governments, survey data from treatment providers and programme evaluation data. The various data sources were reconciled, using published studies of treatment activity, to estimate the unique number of treatment recipients. SETTING Treatment funded by the Australian and state/territory governments provided by general practitioners, specialist treatment services, hospitals, community- and hospital-based ambulatory mental health-care services and allied health professionals. PARTICIPANTS People receiving AOD treatment in the above settings. MEASURES Annual quantum of AOD treatment (encounters, episodes, consultations) and the number of unique treatment recipients. FINDINGS In 2011/12 we estimated 1.6 million episodes of care, consultations or encounters, noting that measures of treatment are not comparable. Based on a range of conversion rates to account for people accessing treatment multiple times in that year, we estimated that the number of Australians in receipt of AOD treatment ranged from 202 168 to 232 419. This is an underestimate and subject to error. Using the upper range of the estimate, on average each treatment recipient made 4.7 visits to a general practitioner (GP) or allied health professional providing mental health services for AOD treatment, and had 1.2 treatment episodes with a specialist AOD treatment provider and/or hospital. CONCLUSIONS Between 202 168 and 232 419 Australians are estimated to have received alcohol and other drug treatment in 2011-12. The comprehensive approach used to calculate this estimate, combining multiple independent data sets across treatment settings and programmes, can be replicated in other countries.
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Affiliation(s)
- Jenny Chalmers
- National Drug and Alcohol Research Centre, UNSW Australia, Australia.
| | - Alison Ritter
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW Australia, Australia
| | - Lynda Berends
- National Drug and Alcohol Research Centre, UNSW Australia, Australia
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24
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Edmond MB, Aletraris L, Roman PM, Fields DL, Bride BE. The United States' Federal Parity Act and treatment of substance use disorders: Administrators' familiarity and perceptions of impact. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 34:80-7. [PMID: 27450320 DOI: 10.1016/j.drugpo.2016.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/17/2015] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The 2008 Wellstone and Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) aims to secure parity in private insurance coverage between behavioral and other medical disorders in the United States (U.S.). This legislation represents an important change in the operating field of substance use disorder treatment, but to date, its impact on treatment centers has not been widely examined. The current study measured the extent of center leaders' familiarity with the MHPAEA and their perceptions of its overall impact on their centers. METHODS Using a nationally representative sample of treatment centers in the U.S., we examined the extent of MHPAEA familiarity and its perceived impact as reported by treatment center leaders. We further employed logistic and ordered logistic regressions to determine personal and organizational characteristics associated with their reported familiarity and experienced impacts, including changes in the number of privately-insured clients seeking treatment and in the treatment coverage of those clients. RESULTS We found that dissemination of parity information was low. Only 36% of administrators reported high levels of familiarity and 16% used professional sources of information. The majority of administrators (71%) reported no impact of the legislation on their organization, but those that reported any impact were more likely to state positive impact. Greater parity knowledge and perceived positive impacts were associated with administrator and organizational characteristics indicative of greater access to industry-specific knowledge, a medical model orientation, and reliance on private insurance revenue. CONCLUSION This study demonstrates that dissemination of parity information is lacking and that the majority of leaders have yet to experience an impact of the MHPAEA. Leaders of centers with more sophisticated structures are most likely to be familiar with the legislation and perceive a positive impact. Research concerning the effective management of treatment centers, including environmental scanning techniques, continues to be needed.
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Affiliation(s)
- Mary B Edmond
- Owens Institute for Behavioral Research, University of Georgia, Barrow Hall, Athens, GA 30602, United States.
| | - Lydia Aletraris
- Owens Institute for Behavioral Research, University of Georgia, Barrow Hall, Athens, GA 30602, United States
| | - Paul M Roman
- Owens Institute for Behavioral Research, University of Georgia, Barrow Hall, Athens, GA 30602, United States
| | - Dail L Fields
- Owens Institute for Behavioral Research, University of Georgia, Barrow Hall, Athens, GA 30602, United States
| | - Brian E Bride
- School of Social Work, Georgia State University, Urban Life Building, Suite 1243, Atlanta, GA 30303, United States
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25
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Effects of mental health benefits legislation: a community guide systematic review. Am J Prev Med 2015; 48:755-66. [PMID: 25998926 PMCID: PMC4700502 DOI: 10.1016/j.amepre.2015.01.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/05/2015] [Accepted: 01/30/2015] [Indexed: 11/21/2022]
Abstract
CONTEXT Health insurance benefits for mental health services typically have paid less than benefits for physical health services, resulting in potential underutilization or financial burden for people with mental health conditions. Mental health benefits legislation was introduced to improve financial protection (i.e., decrease financial burden) and to increase access to, and use of, mental health services. This systematic review was conducted to determine the effectiveness of mental health benefits legislation, including executive orders, in improving mental health. EVIDENCE ACQUISITION Methods developed for the Guide to Community Preventive Services were used to identify, evaluate, and analyze available evidence. The evidence included studies published or reported from 1965 to March 2011 with at least one of the following outcomes: access to care, financial protection, appropriate utilization, quality of care, diagnosis of mental illness, morbidity and mortality, and quality of life. Analyses were conducted in 2012. EVIDENCE SYNTHESIS Thirty eligible studies were identified in 37 papers. Implementation of mental health benefits legislation was associated with financial protection (decreased out-of-pocket costs) and appropriate utilization of services. Among studies examining the impact of legislation strength, most found larger positive effects for comprehensive parity legislation or policies than for less-comprehensive ones. Few studies assessed other mental health outcomes. CONCLUSIONS Evidence indicates that mental health benefits legislation, particularly comprehensive parity legislation, is effective in improving financial protection and increasing appropriate utilization of mental health services for people with mental health conditions. Evidence was limited for other mental health outcomes.
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Fernandez J, Lang M. Suicide and organ donors: spillover effects of mental health insurance mandates. HEALTH ECONOMICS 2015; 24:491-497. [PMID: 24523052 DOI: 10.1002/hec.3037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 11/13/2013] [Accepted: 01/02/2014] [Indexed: 06/03/2023]
Abstract
This paper considers the effect of mental health insurance mandates on the supply of cadaveric donors. We find that enacting a mental health mandate decreases the count of organ donors from suicides and results are driven by female donors. Using a number of empirical specifications, we calculate that the mental health parity laws are responsible for an approximately 0.52% decrease in cadaveric donors. Additional regression results show that the mandates are not related to other types of organ donations, ruling out the possibility that the mandates are related to an overall trend in the supply of organ donations. The findings suggest that future policies aimed at reducing suicide in a large and significant way can potentially increase the inefficiency that currently exists in the organ donor market.
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Affiliation(s)
- Jose Fernandez
- College of Business, University of Louisville, Louisville, KY, USA
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27
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Chatterji P, Decker SL, Markowitz S. The effects of mandated health insurance benefits for autism on out-of-pocket costs and access to treatment. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2015; 34:328-353. [PMID: 25893237 PMCID: PMC7512023 DOI: 10.1002/pam.21814] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
As of 2014, 37 states have passed mandates requiring many private health insurance policies to cover diagnostic and treatment services for autism spectrum disorders (ASDs). We explore whether ASD mandates are associated with out-of-pocket costs, financial burden, and cost or insurance-related problems with access to treatment among privately insured children with special health care needs (CSHCNs). We use difference-in-difference and difference-in-difference-in-difference approaches, comparing pre--post mandate changes in outcomes among CSHCN who have ASD versus CSHCN other than ASD. Data come from the 2005 to 2006 and the 2009 to 2010 waves of the National Survey of CSHCN. Based on the model used, our findings show no statistically significant association between state ASD mandates and caregivers' reports about financial burden, access to care, and unmet need for services. However, we do find some evidence that ASD mandates may have beneficial effects in states in which greater percentages of privately insured individuals are subject to the mandates. We caution that we do not study the characteristics of ASD mandates in detail, and most ASD mandates have gone into effect very recently during our study period.
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Affiliation(s)
- Pinka Chatterji
- National Bureau of Economic Research and Department of Economics at the State University of New York at Albany, Albany, NY.
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28
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Cuellar AE, Cheema J. Health Care Reform, Behavioral Health, and the Criminal Justice Population. J Behav Health Serv Res 2014; 41:447-59. [DOI: 10.1007/s11414-014-9404-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lang M. The impact of mental health insurance laws on state suicide rates. HEALTH ECONOMICS 2013; 22:73-88. [PMID: 22184054 DOI: 10.1002/hec.1816] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 08/25/2011] [Accepted: 10/26/2011] [Indexed: 05/31/2023]
Abstract
In the 1990s and early 2000s, a number of states passed laws requiring mental health benefits to be included in health insurance coverage. The variation in the characteristics and enactment date of the laws provides an opportunity to measure the impact of increasing access to mental health care on mental health outcomes, as evidenced by state suicide rates. In contrast with previous research, results show that when states enact laws requiring insurance coverage to include mental health benefits at parity with physical health benefits, the suicide rate decreases significantly by 5%. The findings are robust to a number of specifications and falsification tests.
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Affiliation(s)
- Matthew Lang
- Department of Economics, Xavier University, Cincinnati, Ohio 45207, USA.
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30
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Pecoraro A, Ma M, Woody GE. The science and practice of medication-assisted treatments for opioid dependence. Subst Use Misuse 2012; 47:1026-40. [PMID: 22676570 DOI: 10.3109/10826084.2012.663292] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper briefly reviews the evolution of opioid addiction treatment from humanitarian to scientific and evidence-based, the evidence bases supporting major medication-assisted treatments and adjunctive psychosocial techniques, as well as challenges faced by clinicians and treatment providers seeking to provide those treatments. Attitudes, politics, policy, and financial issues are discussed.
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Affiliation(s)
- Anna Pecoraro
- Perelman School of Medicine, University of Pennsylvania, 150 S.Independence Mall West, Philadelphia, PA 19106-3414, USA
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