RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, United States.
University of North Carolina Wilmington, 601 S. College Road, Wilmington, NC 28043-5920, United States.
J Health Econ. 2018 Jul;60:177-197. doi: 10.1016/j.jhealeco.2018.06.004. Epub 2018 Jun 30.
We estimate the effect of health insurance coverage on opioid use disorder treatment utilization and availability by exploiting cross-state variation in effective dates of Medicaid expansions under the Affordable Care Act. Using a difference-in-differences design, we find that aggregate opioid admissions to specialty treatment facilities increased 18% in expansion states, most of which involved outpatient medication-assisted treatment (MAT). Opioid admissions from Medicaid beneficiaries increased 113% without crowding out admissions from individuals with other health insurance. These effects appeared to be driven by market entry of select MAT providers and by greater acceptance of Medicaid payments among existing MAT providers. Moreover, effects were largest in expansion states with comprehensive MAT coverage. Our findings suggest that Medicaid expansions resulted in substantial utilization and availability gains to clinically efficacious and cost-effective pharmacological treatments, implying potential benefits of expanding Medicaid to non-expansion states and extending MAT coverage.
我们通过利用《平价医疗法案》下医疗补助扩大计划生效日期在各州之间的差异，来评估医疗保险覆盖范围对阿片类药物使用障碍治疗利用和可及性的影响。采用双重差分设计，我们发现，在扩大计划实施的州，专科治疗机构的阿片类药物总入院人数增加了 18%，其中大部分涉及门诊药物辅助治疗（MAT）。医疗补助受益人的阿片类药物入院人数增加了 113%，而没有排挤其他有健康保险的人的入院人数。这些影响似乎是由特定 MAT 提供者的市场进入以及现有 MAT 提供者对医疗补助支付的更大接受程度所驱动的。此外，在 MAT 覆盖范围全面的扩大计划实施州，效果最大。我们的研究结果表明，医疗补助的扩大带来了大量临床有效和具有成本效益的药物治疗的利用和可及性，这意味着将医疗补助扩大到非扩大计划实施州并扩大 MAT 覆盖范围可能带来潜在的好处。
