Abraham Amanda J, Rieckmann Traci, Andrews Christina M, Jayawardhana Jayani
Dr. Abraham is with the Department of Public Administration and Policy and Dr. Jayawardhana is with the Department of Clinical and Administrative Pharmacy, University of Georgia, Athens (e-mail:
Psychiatr Serv. 2017 Jan 1;68(1):41-47. doi: 10.1176/appi.ps.201500470. Epub 2016 Aug 15.
Medications for treatment of substance use disorders are underutilized in treatment programs in the United States. Little is known about how insurance enrollment within states affects treatment program decisions about whether to offer medications. The primary objective of the study was to examine the impact of health insurance enrollment on availability of substance use disorder medications among treatment programs.
Data from the 2012 National Survey of Substance Abuse Treatment Services, National Survey on Drug Use and Health, American Community Survey, Area Health Resource File, and the Substance Abuse and Mental Health Services Administration were combined to examine the impact of state insurance enrollment on availability of substance use disorder medications in treatment programs (N=9,888). A two-level, random-intercept logistic regression model was estimated to account for potential unobserved heterogeneity among treatment programs nested in states.
The percentage of state residents with employer-based insurance and Medicaid was associated with greater odds of offering at least one medication among treatment programs. A 5% increase in the rate of private insurance enrollment was associated with a 7.7% increase in the probability of offering at least one medication, and a 5% increase in the rate of state Medicaid enrollment was associated with a 9.3% increase in the probability of offering at least one medication.
Results point to the potential significance of health insurance enrollment in shaping the availability of substance use disorder medications. Significant expansions in health insurance enrollment spurred by the Affordable Care Act have the potential to increase access to medications for many Americans.
在美国的治疗项目中，用于治疗物质使用障碍的药物未得到充分利用。关于各州的保险参保情况如何影响治疗项目关于是否提供药物的决策，人们知之甚少。该研究的主要目的是检验医疗保险参保情况对治疗项目中物质使用障碍药物可及性的影响。
将2012年全国药物滥用治疗服务调查、全国药物使用和健康调查、美国社区调查、地区卫生资源档案以及药物滥用和精神健康服务管理局的数据相结合，以检验州保险参保情况对治疗项目中物质使用障碍药物可及性的影响（N = 9888）。估计了一个两级随机截距逻辑回归模型，以考虑嵌套在各州内的治疗项目之间潜在的未观察到的异质性。
参加雇主提供保险和医疗补助的州居民比例与治疗项目中提供至少一种药物的几率更高相关。私人保险参保率增加5%与提供至少一种药物可能性增加7.7%相关，州医疗补助参保率增加5%与提供至少一种药物可能性增加9.3%相关。
结果表明医疗保险参保情况在塑造物质使用障碍药物可及性方面具有潜在重要性。《平价医疗法案》推动的医疗保险参保大幅扩张有可能增加许多美国人获得药物的机会。
