Cover: Drug and Alcohol Treatment Among Privately Insured Patients

Drug and Alcohol Treatment Among Privately Insured Patients

Rate of Specialty Substance Abuse Treatment and Association with Cost-Sharing

Published in: Drug and Alcohol Dependence, v. 71, no. 2, Aug. 20, 2003, p. 153-159

Posted on 2003

by Bradley D. Stein, Weiying Zhang

OBJECTIVE: To examine the rate of formal substance abuse (SA) treatment in a privately insured population, and the association between cost-sharing, residential treatment, and outpatient SA treatment, the authors analyzed claims data for 332442 adults in 41 health plans with comprehensive SA treatment benefits. DESIGN: SA treatment utilization during 1999 and the relationship between patient cost-sharing, gender, and SA diagnosis on SA treatment utilization were examined using a cross-sectional retrospective analysis. RESULTS: Only 0.37% (n=1230) of adults had a SA related claim during 1999. Individuals in plans with higher levels of cost-sharing had lower rates of residential SA treatment and specialty SA outpatient treatment compared to individuals in plans with lower cost-sharing, adjusting for age, sex, and SA diagnosis. CONCLUSIONS: Few individuals had SA related claims, raising questions about rates of undocumented treatment, out-of-network treatment, and unmet need for treatment in the privately insured, and its implications for assessing the quality of SA treatment available in private health plans. At a time when levels of cost-sharing are increasing among privately insured individuals, consideration should be given the potential impact of such changes on the treatment of individuals requiring specialty SA treatment.

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