MANAGED CARE AND ACCESS TO ALCOHOL TREATMENT SERVICES

此应用程序响应NIAAA的计划公告（PA-97-066） 现有卫生服务数据集的二次分析。 到 提供及时和最新的政策相关信息，我们建议 对为NIAAA资助的项目收集的数据进行二次分析 农村饮酒研究（AA 10372-农村饮酒服务使用和过程 饮酒者）。 农村酒精研究是一项四波纵向调查 733名居住在南方六个州的社区居民， 目前酒精依赖/滥用筛查呈阳性。 具体 此应用程序的目标直接响应NIAAA的健康服务 国家咨询理事会确定的研究优先事项 酒精滥用和酒精中毒的健康服务研究小组委员会。 具体来说，为了响应NIAAA最重要的健康服务研究， 管理式医疗的优先权，我们建议描述物质滥用 福利覆盖面的社区为基础的风险饮酒者，并审查 特定管理式医疗保健计划特征对高危人群的影响 饮酒者获得和利用酒精治疗服务的情况。 自我报告的服务利用率将通过提取 医疗记录和保险账单记录。 同样，自- 报告的健康计划特征将通过 从保险公司获得的福利证明的抽象。 福利证明书的摘要将提供准确的 关于按人头收费、守门、提供商选择限制的信息， 精神健康福利、共同保险、免赔额、共付额 以及服务使用的年度/终身限制。 因为所有的科目 农村酒精研究是目前处于危险之中的饮酒者，这个数据集提供了 一个描述和评估药物滥用的独特机会 为可能有需要的人群提供的福利 酒精治疗。 医学研究所最近发表了 关于管理行为卫生保健研究的建议 大力强调审查儿童获得教育机会问题的重要性， 高风险人群，如本申请中研究的人群。

This application responds to NIAAA's Program Announcement (PA-97-066) entitled Secondary Analysis of Existing Health Services Data Sets. To provide timely and current policy relevant information, we propose to conduct secondary analyses of data being collected for the NIAAA-funded Rural Alcohol Study (AA10372-Service Use and Course of Drinking in Rural Drinkers). The Rural Alcohol Study is a four-wave longitudinal survey of 733 community-based individuals living in six Southern states who screened positive for current alcohol dependence/abuse. The specific aims of this application respond directly to NIAAA's health services research priorities as defined by the National Advisory Council on Alcohol Abuse and Alcoholism's Subcommittee on Health Services Research. Specifically, in response to NIAAA's foremost health services research priority on managed care, we propose to describe the substance abuse benefits coverage of community-based at-risk drinkers and examine the impact of specific managed care health plan characteristics on at-risk drinkers' access to and utilization of alcohol treatment services. Self-reported service utilization will be verified by abstracting both provider medical records and insurance billing records. Likewise, self- reported characteristics of health plans will be verified via the abstraction of the certificates of benefits obtained from insurers. Abstraction of the certificate of benefits will provide accurate information about capitation, gatekeeping, provider choice restrictions, carved-out mental health benefits, coinsurance, deductibles, copayments and annual/lifetime limits on service use. Because all subjects in the Rural Alcohol Study are current at-risk drinkers, this dataset provides a unique opportunity to describe and evaluate the substance abuse benefits coverage for a population of individuals potentially in need of alcohol treatment. The Institute of Medicine's recently published recommendations concerning managed behavioral health care research strongly emphasize the importance of examining issues of access for high-risk populations such as the one investigated in this application.