Treatment for substance use disorders in a privately insured population under managed care: Costs and services use

Greenfield, Shelly F.; Azzone, Vanessa; Huskamp, Haiden; Cuffel, Brian; Croghan, Thomas; Goldman, William; Frank, Richard G.

doi:10.1016/j.jsat.2004.07.002

Next »Journal of Substance Abuse Treatment
Volume 27, Issue 4 , Pages 265-275, December 2004

Treatment for substance use disorders in a privately insured population under managed care:

Costs and services use

Shelly F. Greenfield, M.D., M.P.H.
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Corresponding author. McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA. Tel.: +1 617 855 2241; fax: +1 617 855 2699
Vanessa Azzone, Ph.D.
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
Haiden Huskamp, Ph.D.
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
Brian Cuffel, Ph.D.
- United Behavioral Health, San Francisco, CA 94105, USA
Thomas Croghan, M.D.
- RAND Corporation, Arlington, VA 22202-5050, USA
William Goldman, M.D.
- United Behavioral Health, San Francisco, CA 94105, USA
Richard G. Frank, Ph.D.
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA

Received 10 October 2003; received in revised form 15 June 2004; accepted 9 July 2004.

Abstract

The study investigated the relationship of substance use disorders, concurrent psychiatric disorders, and patient demographics to patterns of treatment use and spending in behavioral health and medical treatment sectors. We examined claims data for individuals covered by the same organization. Services spending and use were examined for 1899 individuals who received substance use disorder treatment in 1997. Medical and pharmacy spending was assessed for 590 individuals (31.1%). The most prevalent services were outpatient, intensive outpatient, residential, and detoxification. Average mental health/substance abuse (MHSA) care spending conditional on use was highest for those with concurrent alcohol and drug disorders ($5235) compared to those with alcohol ($2507) or drugs ($3360) alone; other psychiatric illness ($4463) compared to those without ($1837); and employees’ dependents ($4138) compared to employees ($2875) or their spouses ($2744). A significant minority also sought MHSA services in the medical sector. Understanding services use and associated costs can best be achieved by examining services use across treatment sectors.

Keywords: Health care utilization, Mental health services, Employee health insurance, Substance abuse treatment, Client characteristics