Impact Of Medicaid Expansion On Coverage And Treatment Of Low-Income Adults With Substance Use Disorders
Impact Of Medicaid Expansion On Coverage And Treatment Of Low-Income Adults With Substance Use Disorders
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DOI：
10.1377/hlthaff.2018.0124
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发表时间：
2018-08-01
期刊：
影响因子：
9.7
通讯作者：
Mojtabai, Ramin
中科院分区：
文献类型：
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作者：
Olfson, Mark;Wall, Melanie;Mojtabai, Ramin
药物使用障碍的广泛治疗不足引起了人们对《平价医疗法案》（ACA）下扩大医疗补助资格是否促进了这些疾病的覆盖和治疗的关注。我们评估了2014年ACA医疗补助计划扩大后低收入成人药物使用障碍的覆盖范围和药物使用障碍治疗的变化，使用了2008-15年全国药物使用和健康调查的数据。有药物使用障碍的低收入扩张州居民未参保的比例从2012-13年的34.4%下降到2014-15年的20.4%，而未扩张州居民的相应比例从45.2%下降到38.6%。然而，在扩张或非扩张状态下，总体物质使用障碍治疗没有相应的增加。保险覆盖范围的差异增加表明，医疗补助计划的扩张促进了保险收益，但没有观察到相应的治疗收益。增加治疗可能需要将药物使用障碍治疗与其他医疗服务和临床干预措施结合起来，以激励人们参与治疗。
Extensive undertreatment of substance use disorders has focused attention on whether the expansion of eligibility for Medicaid under the Affordable Care Act (ACA) has promoted increased coverage and treatment of these disorders. We assessed changes in coverage and substance use disorder treatment among low-income adults with the disorders following the 2014 ACA Medicaid expansion, using data for 2008-15 from the National Survey on Drug Use and Health. The percentage of low-income expansion state residents with substance use disorders who were uninsured decreased from 34.4 percent in 2012-13 to 20.4 percent in 2014-15, while the corresponding decrease among residents of nonexpansion states was from 45.2 percent to 38.6 percent. However, there was no corresponding increase in overall substance use disorder treatment in either expansion or nonexpansion states. The differential increase in insurance coverage suggests that Medicaid expansion contributed to insurance gains, but corresponding treatment gains were not observed. Increasing treatment may require the integration of substance use disorder treatment with other medical services and clinical interventions to motivate people to engage in treatment.