BENEFITS OF TREATMENT SERVICES

管理式医疗和政府支出的削减增加了减少医疗支出的必要性。因此，药物治疗计划不得不减少治疗停留时间，并提供更少的治疗服务。尽管了解治疗服务的这些变化如何影响结果，更具体地说，了解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，对这些问题进行系统审查的工作很少。虽然以前的研究已经开发出确定药物治疗本身是否具有成本效益的方法，但它们没有审查个别治疗服务的经济影响。我们拟议的对现有数据库的分析提供了一种系统的方法，旨在估计个别治疗服务对经济结果的影响，并确定哪些服务最具成本效益。通过专注于个人服务，这种方法填补了研究中的一个空白，旨在扩大药物治疗的经济模式。研究结果应向政策制定者和治疗提供者提供有关治疗服务与结果之间关系的重要信息，从而帮助他们设计一揽子服务，最大限度地提高每一美元的治疗结果。这项分析的数据来自国民待遇改善评估研究(NTIES)。NTIES数据库由1992年至1995年收集的数据组成，是在病人一级和服务利用一级详细研究治疗服务的最大现有资源之一。由于NTIES的项目和患者都是不同的，我们将把这项工作的重点放在最大的治疗模式-门诊免药上。我们分析的具体目的是1)估计向药物治疗患者提供的每项治疗服务的数量是否与重要的经济结果(就业和犯罪行为)有关；2)确定提供的每项治疗服务的数量与结果之间的关系是线性的还是非线性的；以及3)比较每项治疗服务的增量有形收益和增量成本，以评估每项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.