Clark Robin E, Samnaliev Mihail, McGovern Mark P
Center for Health Policy and Research, University of Massachusetts Medical School, 333 South St., Shrewsbury, MA 01545, USA.
Psychiatr Serv. 2009 Jan;60(1):35-42. doi: 10.1176/ps.2009.60.1.35.
This study measured the impact of substance use disorders on Medicaid expenditures for behavioral and physical health care among beneficiaries with behavioral health disorders.
Claims for Medicaid beneficiaries with behavioral health diagnoses in 1999 from Arkansas, Colorado, Georgia, Indiana, New Jersey, and Washington were analyzed. Behavioral health and general medical expenditures for individuals with diagnoses of substance use disorders were compared with expenditures for those without such diagnoses. States were analyzed separately with adjustment for confounders.
A total of 148,457 beneficiaries met selection criteria, and 43,457 (29.3%) had a substance use diagnosis. Compared with other beneficiaries with behavioral health disorders, individuals with diagnoses of substance use disorders had significantly higher expenditures for physical health problems in five of six states. Approximately half of the additional care and expenditures were for treatment of physical conditions. Differences declined but remained statistically significant after adjustment for higher overall disease burden among beneficiaries with addictions. Medical expenditures for individuals with diagnoses of substance use disorders increased significantly with age in five of six states, whereas behavioral health expenditures were stable or declined. Hospital admissions for psychiatric and general medical reasons were higher for those with diagnoses of substance use disorders.
The impact of addiction on Medicaid populations with behavioral health disorders is greater than the direct cost of mental health and addictions treatment. Higher medical expenditures can be partly attributed to greater prevalence of co-occurring physical disorders, but expenditures remained higher after adjustment for disease burden. Spending estimates based only on behavioral health diagnoses may significantly underestimate addictions-related costs, particularly for older adults.
本研究衡量了物质使用障碍对患有行为健康障碍的医疗补助受益人的行为和身体健康护理支出的影响。
对1999年来自阿肯色州、科罗拉多州、佐治亚州、印第安纳州、新泽西州和华盛顿州的患有行为健康诊断的医疗补助受益人的索赔进行了分析。将诊断为物质使用障碍的个体的行为健康和一般医疗支出与未进行此类诊断的个体的支出进行了比较。对各州分别进行分析，并对混杂因素进行了调整。
共有148,457名受益人符合选择标准，其中43,457名（29.3%）有物质使用诊断。与其他患有行为健康障碍的受益人相比，诊断为物质使用障碍的个体在六个州中的五个州因身体健康问题的支出显著更高。大约一半的额外护理和支出用于身体状况的治疗。在对成瘾受益人中较高的总体疾病负担进行调整后，差异有所下降，但仍具有统计学意义。在六个州中的五个州，诊断为物质使用障碍的个体的医疗支出随年龄显著增加，而行为健康支出则稳定或下降。诊断为物质使用障碍的个体因精神科和一般医疗原因的住院率更高。
成瘾对患有行为健康障碍的医疗补助人群的影响大于心理健康和成瘾治疗的直接成本。较高的医疗支出部分可归因于共病身体疾病的患病率较高，但在对疾病负担进行调整后，支出仍然较高。仅基于行为健康诊断的支出估计可能会显著低估与成瘾相关的成本，尤其是对老年人而言。
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