BENEFITS OF TREATMENT SERVICES

管理式医疗和政府支出的减少增加了减少保健支出的必要性。因此，药物治疗项目不得不缩短治疗时间，提供更少的治疗服务。虽然了解治疗服务的这些变化如何影响结果，更具体地说，哪些治疗服务最具成本效益是至关重要的，但令人惊讶的是，很少有工作系统地检查这些问题。虽然以前的研究已经开发出了确定药物治疗本身是否具有成本效益的方法，但它们并没有检查个别治疗服务的经济效果。我们提出的对现有数据库的分析提供了一种系统的方法，旨在评估个体治疗服务对经济结果的影响，并确定哪种服务最具成本效益。该方法通过关注个体服务，填补了研究空白，旨在扩展药物治疗的经济模式。这项研究的结果应该为政策制定者和治疗提供者提供关于治疗服务和结果之间关系的重要信息，从而帮助他们设计服务方案，使每一美元治疗支出的结果最大化。这项分析的数据来自国家治疗改善评估研究（NTIES）。NTIES数据库由1992年至1995年收集的数据组成，是在患者水平和服务利用水平上详细研究治疗服务的最大现有资源之一。由于NTIES的项目和患者都是异质的，我们将把这项工作集中在最大的治疗方式-门诊无药。我们分析的具体目的是：1)估计向药物治疗患者提供的每种治疗服务的数量是否与经济上重要的结果（就业和犯罪行为）有关；2)确定所提供的每种治疗服务量与结果之间的关系是线性的还是非线性的；3)比较每种治疗服务的增量有形收益与增量成本，以评估每种治疗服务是否具有成本效益。

Managed care and reductions in government spending have increased the need to reduce health care expenditures. Consequently, drug treatment programs have had to reduce treatment length of stay and to provide fewer treatment services. Although it is vitally important to understand how these changes in treatment services are affecting outcomes and, more specifically, which treatment services are most cost-beneficial, surprisingly little work has been done that systematically examines these issues. While previous studies have developed approaches for determining whether drug treatment itself is cost-beneficial, they have not examined the economic effects of individual treatment services. Our proposed analysis of an existing database offers a systematic approach aimed at estimating the effect of individual treatment services on economic outcomes and at determining which services are most cost-beneficial. By focusing on individual services, this approach fills a gap in the research and aims at extending the economic model of drug treatment. The results of the study should provide important information to policymakers and treatment providers on the relationship between treatment services and outcomes, thereby aiding them in designing service packages that maximize outcomes per dollar spent on treatment. Data for this analysis come from the National Treatment Improvement Evaluation Study (NTIES). Composed of data collected from 1992 through 1995, the NTIES database is one of the largest existing resources for the detailed study of treatment services at both the patient level and the service-utilization level. Because both the programs and the patients in NTIES were heterogeneous, we will focus this work on the largest treatment modality-outpatient drug-free. The specific aims of our analysis are 1) to estimate whether the amount of each treatment service provided to drug-treatment patients is related to economically important outcomes (employment and criminal behavior); 2) to determine whether the relationship between the amount of each treatment service provided and outcomes is linear or nonlinear; and 3) to compare the incremental tangible benefits to the incremental cost of each treatment service to assess whether each of these services is cost-beneficial.