MANAGED CARE AND ACCESS TO ALCOHOL TREATMENT SERVICES

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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.