Cartwright William S, Solano Paul L
National Institute of Drug Abuse, NIH, 6001 Executive Boulevard, Room 4222, MSC 9565, Bethesda, MD 20892-9565, USA.
Health Policy. 2003 Dec;66(3):247-60. doi: 10.1016/s0168-8510(03)00066-6.
Drug abuse treatment financing exhibits a heterogeneous set of sources from federal, state, and local governments, as well as private sources from insurance, patient out-of-pocket, and charity. A public health model of drug abuse treatment is presented for a market that can be characterized by excess demand in many communities and an implied policy of rationing. According to best estimates, as many as 6.7 million individuals may need treatment, but only an estimated 1.5 million individuals actually participated in treatment episodes. Since, as demonstrated empirically, drug abuse treatment has a robust and positive social net benefit to society, it is perplexing that treatment financing stops with a rationing outcome that inhibits social welfare. The justification for public financing is centered on the external costs of drug addiction, but subsidization is grounded in the reality that a large number of addicted individuals do not have sufficient resources to pay for treatment out-of-pocket, nor do they have private insurance coverage. Social welfare losses are generated by financial arrangements that are inconsistent with rational budgeting theory and as such would lead to non-optimal organization and management of the drug abuse treatment system.
药物滥用治疗资金来源多种多样，包括联邦、州和地方政府，以及保险、患者自付费用和慈善等私人来源。本文针对一个在许多社区可能存在需求过剩且隐含配给政策的市场，提出了一种药物滥用治疗的公共卫生模式。据最佳估计，多达670万人可能需要治疗，但实际接受治疗的人数估计仅为150万。鉴于经验表明，药物滥用治疗对社会具有强大且积极的社会净效益，令人困惑的是，治疗资金却以抑制社会福利的配给结果而告终。公共资金的理由主要基于药物成瘾的外部成本，但补贴的依据是大量成瘾者没有足够的资源自付治疗费用，也没有私人保险覆盖。与合理预算理论不一致的财务安排会造成社会福利损失，进而导致药物滥用治疗系统的组织和管理不理想。
