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

 描述（由申请人提供）：本提案的总体目标是检查2004年至2013年期间在各州实施的美国州平等法律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公平法案》（MHPAEA）预计将彻底改变SUD治疗系统。虽然这些规定尚未得到充分实施，但PPACA下行为健康服务内容的变化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发生重大变化。几年前，一些州实施了一些计划，以扩大私人保险市场的行为健康均等。一些州还制定了医疗补助扩张计划。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。对这些早期州一级计划的评估可以帮助政策制定者预测PPACA和MHPAEA及其州一级变化的未来影响，以描述服务需求或治疗环境变化的预期变化，并确定从这些政策中受益最少的人群。为了实现这些目标，我们目前的项目建议使用2004年至2013年期间参加年度全国药物使用和健康调查的45万多名美国成年人的数据，以及来自治疗事件数据集（TEDS）的国家行政数据由同一时期数百万SUD治疗设施的入院和出院信息组成，以检查州均等的影响和医疗补助扩展计划的模式SUD治疗。我们还旨在研究这些医疗改革是否对特定人群产生了差异性影响，并评估因这些国家改革而接受治疗的个人服务的有效性。我们对这些早期国家改革的评估可能会提供直接适用于未来物质使用障碍护理系统的设计和实施的信息。

 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.