ROLE OF NONPROFIT PROVIDERS: POLICY IMPACTS

酒精处理部门的所有权发生了重大变化 提供程序的组成。虽然私营非营利组织占主导地位， 营利性提供商的市场份额有所增长，公众的份额 供应商已经开始减少。由于非营利性和公共服务提供者 提供大部分无偿社区服务(例如，慈善机构 护理)，所有权结构的变化和增加的财务 所有供应商面临的压力来自于竞争加剧和 未参保的人口对这一制度的持续能力提出了质疑 提供这些服务，并为弱势群体提供机会。 这项拟议的研究将审查非营利组织提供者在 酗酒治疗部门在所有权和融资方面的这些趋势。它 将评估这些趋势对非营利性提供商提供的 社区服务及其关于定价和强度的决定 服务的价值。这项研究还将考察政府的影响 关于所有权构成的供给和融资待遇的政策 酗酒治疗部门的。这项研究包括三个部分。 首先，来自1987年全国医疗机构和治疗单位的数据 毒品和酒精中毒治疗单位调查(NDATUS)将与数据联系起来 关于国家资助政策和关于提供者系统特征的数据 审查向弱势群体提供服务的决定因素 (例如，公共醉酒者治疗方案，少数群体数量 接受住院和门诊治疗的客户是否接受医疗补助 患者，以及酒精中毒客户中静脉吸毒者的百分比)和 服务的强度和成本。第二，L NDATUS数据汇总到 州和大都市区层面将被用来研究 酒精中毒总体市场中非营利性份额的决定因素 治疗服务。第三，住院出院数据摘录自12 各州将被用于检查住院酒精中毒治疗的供应情况 私立非营利医院向医疗补助和未参保患者提供的服务。 这些分析中的每一个都将估计以下类型的 政策变量：医疗补助覆盖范围和支付条款、州福利 授权、整笔赠款资金、提供公有治疗 设施，以及来自国家酒精和毒品机构的可用资金。 其中一些变量的决定因素的模型也将是 估计为两阶段估计过程的第一阶段。

The alcohol treatment sector has experienced major changes in the ownership composition of providers. While private nonprofit providers predominate, the market share of for-profit providers has grown and the share of public providers has begun to decline. Since non-profit and public providers supply the great bulk of non-remunerative community services (e.g., charity care), the changes in ownership structure and the increased financial pressure on all providers from enhanced competition and the increasing uninsured population raise questions about the system's ability to continue providing these services and to maintain access for disadvantaged groups. The proposed study will examine the response of nonprofit providers in the alcoholism treatment sector to these trends in ownership and financing. It will estimate the impacts of these trends on nonprofit providers' supply of community services and on their decisions about pricing and the intensity of services. The study will also examine the impacts of government policies in supplying and financing treatment on the ownership composition of the alcoholism treatment sector. The study has three components. First, individual facility and treatment unit data from the 1987 National Drug and Alcoholism Treatment Unit Survey (NDATUS) will be linked with data on state funding policies and data on provider system characteristics to examine determinants of provision of services to disadvantaged groups (e.g., treatment program for public inebriates, numbers of minority group clients treated as inpatients and outpatients, acceptance of Medicaid patients, and percent of alcoholism clients who were IV drug users) and intensity and costliness of services. Second,l NDATUS data aggregated to the state and metropolitan area level will be used to study the determinants of the nonprofit share of the overall market for alcoholism treatment services. Third, inpatient discharge abstract data from 12 states will be used to examine the supply of inpatient alcoholism treatment services by private nonprofit hospitals to Medicaid and uninsured patients. Each of these analyses will estimate the impacts of the following types of policy variables: Medicaid coverage and payment provisions, state benefit mandates, block grant funds, availability of publicly-owned treatment facilities, and available funds from state alcohol and drug agencies. Models of the determinants of some of these variables will also be estimated as the first stage of two-stage estimation process.