MANAGED CARE AND ACCESS TO ALCOHOL TREATMENT SERVICES

此应用程序响应NIAAA的计划公告(PA-97-066) 题为《现有卫生服务数据集的二次分析》。至 提供及时和最新的政策相关信息，我们建议 对NIAAA资助的数据进行二次分析 农村酒精研究(AA10372--农村地区的服务使用和饮酒过程 饮酒者)。农村酒精研究是一项四波纵向调查 在居住在南方六个州的733名社区个人中， 目前酒精依赖/滥用筛查呈阳性。具体的 此应用程序的目标直接响应NIAAA的医疗服务 国家咨询委员会确定的研究优先事项 酒精滥用和酒精中毒卫生服务研究小组委员会。 具体地说，为了回应NIAAA最重要的卫生服务研究 关于管理性护理的优先事项，我们建议描述物质滥用 社区高危饮酒者的福利覆盖范围，并检查 特定管理型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两者进行验证 提供者的医疗记录和保险账单记录。同样，自我- 所报告的健康计划的特征将通过 提取从保险公司获得的利益证书。 福利证书的摘要将提供准确的 有关资质、看门、提供商选择限制的信息， 分割精神健康福利、共同保险、免赔额、共同支付 以及服务使用的年度/终身限制。因为所有的研究对象都在 农村酒精研究是当前的高危饮酒者，该数据集提供了 描述和评估药物滥用的独特机会 为潜在有需要的个人群体提供的福利 酒精治疗。美国医学研究所最近发表的 关于管理型行为保健研究的建议 强烈强调审查以下问题的重要性： 高危人群，如本应用程序中调查的人群。

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.