Admission Practices And Cost Of Care For Opioid Use Disorder At Residential Addiction Treatment Programs In The US
Admission Practices And Cost Of Care For Opioid Use Disorder At Residential Addiction Treatment Programs In The US
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DOI：
10.1377/hlthaff.2020.00378
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发表时间：
2021-02-01
期刊：
影响因子：
9.7
通讯作者：
Barnett, Michael Lawrence
中科院分区：
文献类型：
--
作者：
Beetham, Tamara;Saloner, Brendan;Barnett, Michael Lawrence
对阿片类药物使用障碍的急性短期住院护理的使用迅速增长，政策制定者主张增加“治疗床”的可用性。“然而，人们对高昂的费用和误导性的招聘做法表示关注。我们在全国范围内对613个住宅项目进行了审计调查，这些项目假扮成使用海洛因和寻求成瘾治疗的无保险现金支付个人。三分之一的来电者在临床评估前被录取，通常在一天内。大多数项目都需要预付款，营利性项目的收费（17,434美元）是非营利组织（5,712美元）的两倍多。招募技术（例如，提供有偿交通）经常被营利性项目使用，但非营利项目则不然。包括在电话会议期间提供入场券、高额预付款和招聘技巧在内的做法，即使在拥有第三方认证和州许可证的项目中也很常见。这些发现引起了人们的担忧，即住宅项目，包括经认证和许可的项目，可能会接纳临床和经济脆弱的人群进行昂贵的治疗，而不评估其他护理环境的适当性。
The use of acute, short-term residential care for opioid use disorder has grown rapidly, with policy makers advocating to increase the availability of "treatment beds." However, there are concerns about high costs and misleading recruitment practices. We conducted an audit survey of 613 residential programs nationally, posing as uninsured cash-paying individuals using heroin and seeking addiction treatment. One-third of callers were offered admission before clinical evaluation, usually within one day. Most programs required up-front payments, with for-profit programs charging more than twice as much ($17,434) as nonprofits ($5,712). Recruitment techniques (for example, offering paid transportation) were used frequently by for-profit, but not nonprofit, programs. Practices including admission offers during the call, high upfront payments, and recruitment techniques were common even among programs with third-party accreditation and state licenses. These findings raise concerns that residential programs, including accredited and licensed ones, may be admitting a clinically and financially vulnerable population for costly treatment without assessing appropriateness for other care settings.