Race/Ethnicity and Geographic Access to Medicaid Substance Use Disorder Treatment Facilities in the United States
Race/Ethnicity and Geographic Access to Medicaid Substance Use Disorder Treatment Facilities in the United States
复制标题
DOI：
10.1001/jamapsychiatry.2013.3575
复制
发表时间：
2014-02-01
期刊：
影响因子：
25.8
通讯作者：
Druss, Benjamin G.
中科院分区：
文献类型：
--
作者：
Cummings, Janet R.;Wen, Hefei;Druss, Benjamin G.
尽管物质使用障碍（SUDs）很普遍，并伴有不良后果，但治愈率仍然很低。与身体和精神健康问题不同，sud的治疗主要由一个单独的专业部门提供，并且更多地由公共资源提供资金。根据《患者保护和平价医疗法案》，医疗补助计划的扩大有可能增加对sud的治疗机会，但前提是要有服务新参保人的基础设施。目的：研究美国各县接受医疗补助的门诊SUD治疗设施的可用性，以及种族/少数民族比例较高的县是否更有可能在这一基础设施方面存在差距。设计、环境和参与者我们使用来自2009年全国药物滥用治疗服务公共使用档案调查和2011-2012年区域资源档案的数据来检查与为医疗补助计划入选者提供SUD治疗设施的县级访问相关的社会人口因素。所有50个州的县都包括在内。我们估计了一个带有各州指标的概率模型，以调整各州在人口、政治和政策方面的异质性。独立变量评估了县的种族/民族构成（即黑人百分比和西班牙裔百分比），贫困人口百分比，农村人口百分比，医疗补助保险百分比，未保险百分比和总人口。主要结局和测量方法：至少有一家接受医疗补助的门诊SUD治疗机构的县的二分指标。结果：大约60%的美国县至少有一家接受医疗补助的门诊SUD设施，尽管这一比例在许多南部和中西部州低于该国其他地区。黑人（边际效应[ME]， -3.1; 95% CI, -5.2%至-0.9%）、农村（-9.2%;-11.1%至-7.4%）和/或无保险（-9.5%;-13.0%至-5.9%）居民比例较高的县不太可能拥有这些设施之一。结论和相关性：通过扩大医疗补助来增加获得SUD治疗的可能性可能会受到当地提供护理设施的限制，特别是对于黑人和/或无保险居民比例高的县和农村县。虽然选择加入扩张的州将为SUD治疗系统获得额外的联邦资金，但可能需要实施额外的政策，以确保在当地社区有足够的地理通道来为新注册的人提供服务。
IMPORTANCE Although substance use disorders (SUDs) are prevalent and associated with adverse consequences, treatment rates remain low. Unlike physical and mental health problems, treatment for SUDs is predominantly provided in a separate specialty sector and more heavily financed by public sources. Medicaid expansion under the Patient Protection and Affordable Care Act has the potential to increase access to treatment for SUDs but only if an infrastructure exists to serve new enrollees.OBJECTIVE To examine the availability of outpatient SUD treatment facilities that accept Medicaid across US counties and whether counties with a higher percentage of racial/ethnic minorities are more likely to have gaps in this infrastructure.DESIGN, SETTING, AND PARTICIPANTS We used data from the 2009 National Survey of Substance Abuse Treatment Services public use file and the 2011-2012 Area Resource file to examine sociodemographic factors associated with county-level access to SUD treatment facilities that serve Medicaid enrollees. Counties in all 50 states were included. We estimated a probit model with state indicators to adjust for state-level heterogeneity in demographics, politics, and policies. Independent variables assessed county racial/ethnic composition (ie, percentage black and percentage Hispanic), percentage living in poverty, percentage living in a rural area, percentage insured with Medicaid, percentage uninsured, and total population.MAIN OUTCOMES AND MEASURES Dichotomous indicator for counties with at least 1 outpatient SUD treatment facility that accepts Medicaid.RESULTS Approximately 60% of US counties have at least 1 outpatient SUD facility that accepts Medicaid, although this rate is lower in many Southern and Midwestern states than in other areas of the country. Counties with a higher percentage of black (marginal effect [ME], -3.1; 95% CI, -5.2% to -0.9%), rural (-9.2%; -11.1% to -7.4%), and/or uninsured (-9.5%; -13.0% to -5.9%) residents are less likely to have one of these facilities.CONCLUSIONS AND RELEVANCE The potential for increasing access to SUD treatment via Medicaid expansion may be tempered by the local availability of facilities to provide care, particularly for counties with a high percentage of black and/or uninsured residents and for rural counties. Although states that opt in to the expansion will secure additional federal funds for the SUD treatment system, additional policies may need to be implemented to ensure that adequate geographic access exists across local communities to serve new enrollees.