McFarland Bentson H, Lynch Frances L, Freeborn Donald K, Green Carla A, Polen Michael R, Deck Dennis D, Dickinson Daniel M
Center for Health Research, Kaiser Permanente Northwest, and the Department of Psychiatry, Oregon Health & Science University, Portland, Oregon 97227, USA.
Med Care. 2006 Jun;44(6):601-6. doi: 10.1097/01.mlr.0000215814.01127.ce.
As Medicaid clients have come to be enrolled in managed care, concerns have arisen about the ability of private sector systems to meet the needs of enrollees with substance abuse problems.
This project describes treatment initiation and duration for Medicaid and commercial substance abuse treatment clients in a large health maintenance organization (HMO).
This study was a prospective secondary analysis of information from HMO databases. Subjects were 641 adult Medicaid clients who contacted the HMO's addiction medicine department in 1996 or 1997 and commercial HMO addiction medicine patients (n=447). First contact with addiction medicine during the study period was the index event.
Chief dependent variables were initiation and duration of substance abuse treatment after the index event.
Logistic regression showed that longer HMO enrollment predicted treatment initiation after substance abuse assessment, but Medicaid status was not a significant predictor. A competing risks analysis using Cox proportional hazards models indicated that once subjects had initiated, Medicaid was not significantly related to exit from substance abuse treatment. Analysis of health plan disenrollment by Medicaid clients indicated that the most common reason was loss of Medicaid eligibility.
These results raise the possibility that state Medicaid policies may make it difficult for clients to obtain suitable chemical dependency treatment services.
随着医疗补助计划的参保者开始加入管理式医疗，人们开始担心私营部门系统是否有能力满足有药物滥用问题的参保者的需求。
本项目描述了一家大型健康维护组织（HMO）中医疗补助计划和商业药物滥用治疗客户的治疗起始情况和持续时间。
本研究是对HMO数据库信息进行的前瞻性二次分析。研究对象为1996年或1997年联系HMO成瘾医学科的641名成年医疗补助计划客户以及商业HMO成瘾医学患者（n = 447） 在研究期间首次接触成瘾医学为索引事件。
主要因变量为索引事件后药物滥用治疗的起始情况和持续时间。
逻辑回归显示，HMO参保时间越长，在药物滥用评估后开始治疗的可能性越大，但医疗补助计划参保状态并非显著预测因素。使用Cox比例风险模型进行的竞争风险分析表明，一旦研究对象开始治疗后，医疗补助计划与停止药物滥用治疗并无显著关联。对医疗补助计划客户退出健康计划情况的分析表明，最常见的原因是失去医疗补助资格。
这些结果增加了一种可能性，即州医疗补助政策可能使客户难以获得合适的化学依赖治疗服务。
