Center for Health Enhancement System Studies, University of Wisconsin-Madison, USA.
Health Aff (Millwood). 2012 May;31(5):1000-8. doi: 10.1377/hlthaff.2011.0326.
The Affordable Care Act is aimed at extending health insurance to more than thirty million Americans, including many with untreated substance use disorders. Will those who need addiction treatment receive it once they have insurance? To answer that question, we examined the experience of Massachusetts, which implemented its own universal insurance law in 2007. As did the Affordable Care Act, the Massachusetts reform incorporated substance abuse services into the essential benefits to be provided all residents. Prior to the law's enactment, the state estimated that a half-million residents needed substance abuse treatment. Our mixed-methods exploratory study thus asked whether expanded coverage in Massachusetts led to increased addiction treatment, as indicated by admissions, services, or revenues. In fact, we observed relatively stable use of treatment services two years before and two years after the state enacted its universal health care law. Among other factors, our study noted that the percentage of uninsured patients with substance abuse issues remains relatively high--and that when patients did become insured, requirements for copayments on their care deterred treatment. Our analysis suggests that expanded coverage alone is insufficient to increase treatment use. Changes in eligibility, services, financing, system design, and policy may also be required.
平价医疗法案旨在为超过 3000 万美国人提供医疗保险，其中包括许多患有未经治疗的物质使用障碍的人。一旦他们有了保险，那些需要接受成瘾治疗的人会得到治疗吗？为了回答这个问题，我们考察了马萨诸塞州的经验，该州在 2007 年实施了自己的全民保险法。与平价医疗法案一样，马萨诸塞州的改革将药物滥用服务纳入所有居民都应享受的基本福利中。在该法律颁布之前，该州估计有 50 万居民需要药物滥用治疗。因此，我们的混合方法探索性研究询问了在马萨诸塞州扩大覆盖范围是否会导致成瘾治疗的增加，这可以通过入院、服务或收入来衡量。事实上，我们观察到在该州颁布全民医疗保险法之前和之后的两年内，治疗服务的使用相对稳定。在其他因素中，我们的研究指出，有物质滥用问题的未参保患者的比例仍然相对较高--而且当患者确实获得了保险，他们的医疗费用自付额要求也会阻碍治疗。我们的分析表明，仅仅扩大覆盖范围不足以增加治疗的使用。资格、服务、融资、系统设计和政策的变化也可能是必要的。
