Managed care risk contracts and substance abuse treatment.

Several pending health care bills propose employer mandates to improve coverage for substance abuse treatment. In today's managed care environment, however, mandating "nominal" benefits no longer may achieve intended goals. This paper estimates how one managed care arrangement, shifting risk to the organization managing care, affects substance abuse treatment. Full risk plans do not differ in access rates to any substance abuse treatments or inpatient treatment, but they significantly lower costs per use (by about $470, or 17%).