Utilization of medical services by alcoholics participating in an outpatient treatment program

Alcoholism treatment offset effects: an insurance perspective

This study investigates whether alcoholism treatment costs are offset by reductions in other medical treatment costs by comparing people treated for alcoholism with a matched comparison group. The alcoholism treatment group is defined by diagnoses of alcohol dependence, abuse, or psychoses from health insurance claims field between January 1980 and June 1987. A comparison sample was matched on age, gender, and insurance coverage. In this primarily methodological study, expected costs for nonalcoholism treatments were calculated from standardized regressions. Offset effects were measured from the insurer's perspective through differences in expected total nonalcoholism treatment costs in the periods preceding and following alcoholism treatment. Members of the alcoholism treatment group were more likely than the comparison group to be hospitalized and to need other (nonalcoholism) medical treatment, thus incurring higher total costs. Offset effects emerged for patients with alcohol abuse and without mental psychosis comorbidities.

Longitudinal characteristics of hospital use before and after alcoholism treatment

The frequency of inpatient hospital care for three years before and three years after alcoholism treatment was evaluated for a group of 255 patients of predominantly lower socioeconomic status treated for alcoholism at a rural midwestern medical center in 1983. Subjects were interviewed while in treatment to obtain information regarding alcoholism history and demographics. Hospital care was ascertained from an electronic data file of discharges from 172 acute care hospitals throughout the United States and Puerto Rico. One-third of the sample was never hospitalized for an alcohol-related condition in the years prior to or after alcoholism treatment, and 23% of the sample experienced no hospitalizations at all other than the treatment episode when interviewed. The majority of hospital stays before and after treatment were attributed to alcohol abuse. The frequency and total hospital length of stay for alcohol-related admissions increased yearly before treatment, peaked in the year after treatment, and then declined, but not to earliest pretreatment levels. Subjects experienced significantly more hospitalizations and length of stay after alcoholism treatment than before when comparing both the two three-year periods and the immediate 12 months before and after treatment. More frequent hospital care was also significantly associated with higher levels of daily alcohol consumption and drinking duration but not with sociodemographic indicators.

Assessing consumer benefit. Cost offset as an incidental effect of psychotherapy

In addition to improved quality of care, evidence of cost benefits associated with the provision of consultation-liaison services may be used to justify the expenses of such programs. Reductions in use of medical services following mental health treatments are not inevitable, however. Advocates of C-L should be aware of the circumstances under which cost benefits are likely to be found and focus assessments appropriately.

Comparison of utilization of medical services by alcoholics and non-alcoholics

To determine whether medical costs for alcoholics are higher than those for non-alcoholics, inpatient and outpatient costs for medical services of 191 alcoholics with 191 non-alcoholic matched controls were compared over four years. Results confirm that alcoholics are higher-cost users of medical services than non-alcoholics. (Am J Public Health 1982; 72:600-602.)

Effect of coverage on use of an HMO alcoholism treatment program, outcome, and medical care utilization

Two-hundred-fifty alcoholics were randomly assigned to a full benefit of 50 per cent copayment group before entering an HMO (health maintenance organization) alcoholism treatment program. Data on use of treatment services, use of medical care services, and drinking behavior were collected for one year after intake. The medical care utilization and drinking behavior data were compared to data for the year before intake. The two coverage groups were comparable on sociodemographic characteristics and baseline drinking behavior, but the full benefit group tended to have higher utilization rates for the year prior to intake and significantly more treatment contracts than those having the 50 per cent copayment requirement. Changes in use of medical care services were similar in both groups. Both payment groups improved, but the full benefit group tended to be somewhat more improved. Regression analysis supported the relative unimportance of extent of alcoholism coverage in affecting outcome and subsequent medical care utilization.

Utilization of medical services by alcoholics participating in a health maintenance organization outpatient treatment program: three-year follow-up

IN a cumulative 3-yr follow-up study of utilization of medical services by alcoholics participating in a health insurance maintenance organization (HMO) outpatient alcoholism treatment program, expenditures of 59 alcoholics were compared with those of 78 alcoholics who chose not to participate. Results show significant differences in dollar cost per patient per year between groups in inpatient expenditures (p = 0.03). When alcoholism clinic costs were excluded from combined inpatient and outpatient expenditures, significance was maintained over the 3 yr (p = 0.02). In combined inpatient and outpatient expenditures including alcoholism treatment costs, the dollar differential between groups was substantial but not statistically significant.