The Impact of State Healthcare Reforms on Treatment of Substance Use Disorders

国家医疗改革对药物滥用障碍治疗的影响

• 批准号: 9412821
• 负责人: Rosa M. Crum
• 金额: $ 24.27万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2020-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9412821
• 关键词: Abstinence; Admission activity; Adoption; Adult; Affordable Care Act; Age; Alcohol or Other Drugs use; Alcohols; American; Assertiveness; Behavioral; Behavioral Model; Caring; Client; Clinical; Communities; Comorbidity; Court Decisions; Data; Data Set; Data Sources; Diagnostic; Drug usage; Effectiveness; Elements; Epidemiology; Face; Federal Government; Future; General Population; Goals; Grant; Health; Health Care Reform; Health Insurance; Health Services; Health Services Accessibility; Improve Access; Individual; Insurance; Insurance Coverage; Laws; Length; Local Government; Medicaid; Mental Health; Minority Groups; Modeling; Outcome; Outpatients; Participant; Patients; Pattern; Placebo Effect; Policies; Policy Maker; Population; Privatization; Program Effectiveness; Regulation; Reporting; Resources; Services; Site; Statutes and Laws; Subgroup; Substance Use Disorder; Surveys; System; Time; Treatment outcome; Uninsured; Variant; Woman; addiction; base; behavioral health; care outcomes; care systems; cost; design; follow-up; improved; outreach; parity; population survey; programs; public health relevance; racial and ethnic; randomized trial; reduced substance use; social; treatment program; treatment services; trend

 DESCRIPTION (provided by applicant): Our overall goal for this proposal is to examine the effects of U.S. state parity laws and Medicaid expansion programs implemented in various states between 2004 through 2013 on treatment of substance use disorders (SUD), unmet need for such treatments and variation in the mix and length of treatments. The Patient Protection and Affordable Care Act (PPACA) of 2010 (fully implemented in 2014) and the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 are expected to change the SUD treatment system drastically. Although these regulations are yet to be fully implemented, variations in the content of behavioral health services under PPACA and the Federal Court decision allowing states to opt out of the Medicaid expansion clause of the PPACA will likely result in significant variations in coverage across states. In years prior, a number of states implemented programs to extend behavioral health parity in the private insurance market. Some states also enacted Medicaid expansion programs. The impact of these programs on the use of SUD treatment services, mix of services, and outcome of treatments has not been fully examined. Assessment of these earlier state-level programs can help policy makers predict the future effects of PPACA and MHPAEA and their state-level variations, to characterize expected changes in demand for services or changes in treatment settings, and to identify groups of individuals who would least benefit from these policies. Towards these aims, our current project proposes to use data from over 450,000 US adults who participated in the annual National Survey of Drug Use and Health between 2004 and 2013, as well as national administrative data from the Treatment Episode Data Sets (TEDS) comprised of information from millions of admissions and discharges to SUD treatment facilities in this same period to examine the impact of state parity and Medicaid expansion programs on patterns of SUD treatments. We also aim to examine whether these health reforms impacted specific subgroups of the population differentially and to assess the effectiveness of services among individuals who received treatment as a result of these state reforms. Our assessment of these earlier state reforms would potentially provide information that is directly applicable to the design and implementation of the future systems of care for substance use disorders.

 描述(由申请人提供)：本提案的总体目标是检查2004至2013年间在各州实施的州平等法和医疗补助扩展计划对物质使用障碍(SUD)治疗的影响、此类治疗的未满足需求以及治疗组合和长度的变化。2010年的《患者保护和平价医疗法案》(PPACA)(2014年全面实施)和2008年的《精神健康平等和成瘾平等法》(MHPAEA)预计将彻底改变SUD治疗系统。尽管这些规定尚未完全实施，但PPACA下行为健康服务的内容不同，以及联邦法院允许各州选择退出PPACA的医疗补助扩展条款的决定，可能会导致各州的覆盖范围有很大差异。几年前，一些州实施了扩大私人保险市场行为健康平等的计划。一些州还颁布了医疗补助扩大计划。这些计划对SUD治疗服务的使用、服务组合和治疗结果的影响尚未得到充分研究。对这些早期州级项目的评估可以帮助政策制定者预测PPACA和MHPAEA及其州级变化的未来影响，确定服务需求的预期变化或治疗环境的变化，并确定从这些政策中受益最少的个人群体。为了实现这些目标，我们目前的项目建议使用2004至2013年间参加年度全国药物使用和健康调查的超过450,000名美国成年人的数据，以及来自治疗事件数据集(TEDS)的国家行政数据，其中包括同期SUD治疗机构的数百万入院和出院信息，以检查州平价和医疗补助扩大计划对SUD治疗模式的影响。我们还旨在检查这些医疗改革是否对特定的人口亚群产生了不同的影响，并评估由于这些国家改革而接受治疗的个人的服务效果。我们对这些早期州改革的评估可能会提供直接适用于未来药物使用障碍护理系统的设计和实施的信息。