The role of health insurance on treatment for opioid use disorders: Evidence from the Affordable Care Act Medicaid expansion
The role of health insurance on treatment for opioid use disorders: Evidence from the Affordable Care Act Medicaid expansion
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DOI：
10.1016/j.jhealeco.2018.06.004
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发表时间：
2018-07-01
影响因子：
3.5
通讯作者：
Witman, Allison E.
中科院分区：
文献类型：
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作者：
Meinhofer, Angelica;Witman, Allison E.
我们通过利用《平价医疗法案》下医疗补助扩张有效日期的跨州变化来估计医疗保险覆盖范围对阿片类药物使用障碍治疗利用率和可用性的影响。使用差异中的差异设计，我们发现，在扩张状态下，专科治疗机构的阿片类药物总入院人数增加了18%，其中大部分涉及门诊药物辅助治疗（MAT）。来自医疗补助受益人的阿片类药物入院人数增加了113%，而没有挤出其他健康保险的个人入院人数。这些影响似乎是由选定的MAT提供者进入市场和现有MAT提供者更大程度地接受医疗补助支付所驱动的。此外，影响最大的扩展国家与全面MAT覆盖。我们的研究结果表明，医疗补助的扩张导致了临床有效和具有成本效益的药物治疗的大量利用和可用性收益，这意味着将医疗补助扩展到非扩张状态和扩大MAT覆盖范围的潜在好处。(C)2018爱思唯尔B.V.保留所有权利。
We estimate the effect of health insurance coverage on opioid use disorder treatment utilization and availability by exploiting cross-state variation in effective dates of Medicaid expansions under the Affordable Care Act. Using a difference-in-differences design, we find that aggregate opioid admissions to specialty treatment facilities increased 18% in expansion states, most of which involved outpatient medication-assisted treatment (MAT). Opioid admissions from Medicaid beneficiaries increased 113% without crowding out admissions from individuals with other health insurance. These effects appeared to be driven by market entry of select MAT providers and by greater acceptance of Medicaid payments among existing MAT providers. Moreover, effects were largest in expansion states with comprehensive MAT coverage. Our findings suggest that Medicaid expansions resulted in substantial utilization and availability gains to clinically efficacious and cost-effective pharmacological treatments, implying potential benefits of expanding Medicaid to non-expansion states and extending MAT coverage. (C) 2018 Elsevier B.V. All rights reserved.