Healthcare Financing & Economics, VA Boston Healthcare System and School of Medicine, Boston University, Boston, MA, USA.
Implement Sci. 2013 Jul 18;8:79. doi: 10.1186/1748-5908-8-79.
Substance use disorders (SUDs) are a substantial problem in the United States (U.S.), affecting far more people than receive treatment. This is true broadly and within the U.S. military veteran population, which is our focus. To increase funding for treatment, the Veterans Health Administration (VA) has implemented several initiatives over the past decade to direct funds toward SUD treatment, supplementing the unrestricted funds VA medical centers receive. We study the 'flypaper effect' or the extent to which these directed funds have actually increased SUD treatment spending.
The study sample included all VA facilities and used observational data spanning years 2002 to 2010. Data were analyzed with a fixed effects, ordinary least squares specification with monetized workload as the dependent variable and funding dedicated to SUD specialty clinics the key dependent variable, controlling for unrestricted funding.
We observed different effects of dedicated SUD specialty clinic funding over the period 2002 to 2008 versus 2009 to 2010. In the earlier period, there is no evidence of a significant portion of the dedicated funding sticking to its target. In the later period, a substantial proportion--38% in 2009 and 61% in 2010--of funding dedicated to SUD specialty clinics did translate into increased medical center spending for SUD treatment. In comparison, only five cents of every dollar of unrestricted funding is spent on SUD treatment.
Relative to unrestricted funding, dedicated funding for SUD treatment was much more effective in increasing workload, but only in years 2009 and 2010. The differences in those years relative to prior ones may be due to the observed management focus on SUD and SUD-related treatment in the later years. If true, this suggests that in a centrally directed healthcare organization such as the VA, funding dedicated to a service is a necessary, but not sufficient condition for increasing resources expended for that service.
物质使用障碍（SUDs）是美国（U.S.）的一个严重问题，影响的人数远远超过接受治疗的人数。这在广义上是如此，在美国退伍军人人口中也是如此，这是我们关注的焦点。为了增加治疗资金，退伍军人健康管理局（VA）在过去十年中实施了几项举措，将资金引导到 SUD 治疗上，补充 VA 医疗中心收到的不受限制的资金。我们研究“粘蝇纸效应”或这些定向资金实际上增加 SUD 治疗支出的程度。
研究样本包括所有 VA 设施，并使用观察数据，时间跨度为 2002 年至 2010 年。数据采用固定效应、普通最小二乘规格进行分析，以货币化工作量为因变量，以专门用于 SUD 专科诊所的资金为关键因变量，同时控制不受限制的资金。
我们观察到在 2002 年至 2008 年期间与 2009 年至 2010 年期间，专门用于 SUD 专科诊所的资金具有不同的影响。在早期阶段，没有证据表明大部分专门资金都能坚持其目标。在后期，专门用于 SUD 专科诊所的资金中有相当大的一部分——2009 年为 38%，2010 年为 61%——转化为医疗中心 SUD 治疗支出的增加。相比之下，只有每一元不受限制的资金中有五分钱用于 SUD 治疗。
与不受限制的资金相比，专门用于 SUD 治疗的资金在增加工作量方面更有效，但仅在 2009 年和 2010 年有效。与前几年相比，这些年的差异可能是由于在后几年中观察到对 SUD 和 SUD 相关治疗的管理重点。如果是这样，这表明在像 VA 这样的集中式医疗组织中，专门用于某项服务的资金是增加该服务资源支出的必要条件，但不是充分条件。
