Fuller Bret E, Rieckmann Traci R, McCarty Dennis J, Ringor-Carty Roz, Kennard Sandy
Department of public health and preventive medicine at Oregon Health and Science University, CB-669, Portland, Oregon 97239, USA.
Psychiatr Serv. 2006 May;57(5):686-91. doi: 10.1176/ps.2006.57.5.686.
This prospective study assessed the impacts of a policy change to Oregon's Medicaid program (Oregon Health Plan; OHP) that eliminated methadone benefits for 60 percent of active methadone patients. Recipients of OHP Standard (expanded Medicaid benefits, which were discontinued after the policy change) self-selected into two groups: those who paid for methadone after the policy change and those who terminated treatment. OHP Plus beneficiaries (traditional Medicaid) did not lose benefits.
A total of 149 patients participated in the study, and interviews were conducted at baseline (time of policy change) and one, three, and 12 months after the policy change. Patients were assessed with the Addiction Severity Index (ASI), Timeline Follow Back assessment, and chart review.
Patients who left treatment because they were unable to pay for methadone services showed significant elevations in ASI composite scores for drug and legal problems at baseline and at two and three months after the policy change. The patients who attempted to self-pay experienced significantly more employment problems than the other two groups. The OHP Standard recipients who paid for their methadone treatment over the year were more likely to have additional resources to pay for methadone, be employed, and have stable housing.
The elimination of methadone treatment benefits in the OHP had substantial negative impacts for patients with the greatest indicators of need.
这项前瞻性研究评估了俄勒冈州医疗补助计划（俄勒冈健康计划；OHP）政策变化的影响，该政策取消了60%正在接受美沙酮治疗患者的美沙酮福利。OHP标准计划（扩大的医疗补助福利，政策变化后终止）的受益者自行分为两组：政策变化后自费购买美沙酮的患者和终止治疗的患者。OHP Plus受益者（传统医疗补助）未失去福利。
共有149名患者参与了该研究，并在基线（政策变化时）以及政策变化后1个月、3个月和12个月进行了访谈。使用成瘾严重程度指数（ASI）、时间线追溯评估和病历审查对患者进行评估。
因无力支付美沙酮服务费用而停止治疗的患者在基线时以及政策变化后2个月和3个月时，在药物和法律问题的ASI综合评分上显著升高。试图自费支付的患者比其他两组经历了更多的就业问题。在这一年中自费进行美沙酮治疗的OHP标准计划受益者更有可能有额外资源支付美沙酮费用、有工作且住房稳定。
OHP中取消美沙酮治疗福利对需求指标最高的患者产生了重大负面影响。
