Galanter M, Keller D S, Dermatis H, Egelko S
J Addict Dis. 2000;19(3):13-34. doi: 10.1300/J069v19n03_02.
This report examines the impact of managed care (MC) and related developments on substance abuse treatment, and evaluates how it has been associated with a decline in the availability of proper treatment for many addicted patients. A trend toward carve-out and for-profit MC organizations is associated with lower financial incentives for intensive treatment than in earlier staff-model and not-for-profit MC organizations. The value of substance abuse insurance coverage has declined by 75% between 1988 and 1998 for employees of mid-to large-size companies, compared with only an 11.5% decline for general health insurance. The shift towards MC has also been associated with a drastic reduction in frequency and duration of inpatient hospitalization, and there is no clear evidence that this reduction has been offset by a corresponding increase in outpatient support. In a survey of physicians treating addiction, the majority felt that MC had a negative impact on detoxification and rehabilitation, and on their ethical practice of addiction medicine.
本报告探讨了管理式医疗（MC）及相关发展对药物滥用治疗的影响，并评估了其如何与许多成瘾患者获得适当治疗的可及性下降相关联。与早期的员工模式和非营利性管理式医疗组织相比，向独立运营和营利性管理式医疗组织发展的趋势意味着强化治疗的经济激励较低。1988年至1998年间，中大型公司员工的药物滥用保险覆盖价值下降了75%，而一般医疗保险仅下降了11.5%。向管理式医疗的转变还与住院治疗的频率和时长大幅减少有关，而且没有明确证据表明这种减少已被门诊支持的相应增加所抵消。在一项对治疗成瘾的医生的调查中，大多数人认为管理式医疗对戒毒和康复以及他们在成瘾医学方面的道德实践产生了负面影响。
