美国心理健康平权法案和成瘾公平法案通过后对酒精治疗的影响：州平权法案和种族/民族有影响吗？
U.S. alcohol treatment admissions after the Mental Health Parity and Addiction Equity Act: Do state parity laws and race/ethnicity make a difference?
机构信息
Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA.
Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA.
出版信息
J Subst Abuse Treat. 2019 Nov;106:113-121. doi: 10.1016/j.jsat.2019.08.008. Epub 2019 Aug 20.
BACKGROUND
The U.S. Mental Health Parity and Addiction Equity Act (MHPAEA) was a landmark federal policy aimed at increasing access to substance use treatment, yet studies have found relatively weak impacts on treatment utilization. The present study considers whether there may be moderating effects of pre-existing state parity laws and differential changes in treatment rates across racial/ethnic groups.
METHODS
We analyzed data from SAMHSA'S Treatment Episode Data Set (TEDS) from 1999 to 2013, assessing changes in alcohol treatment admission rates across states with heterogeneous, pre-existing parity laws. NIAAA's Alcohol Policy Information System data were used to code states into five groups based on the presence and strength of states' pre-MHPAEA mandates for insurance coverage of alcohol treatment and parity (weak; coverage no parity; partial parity if coverage offered; coverage and partial parity; strong). Regression models included state fixed effects and a cubic time trend adjusting for state- and year-level covariates, and assessed MHPAEA main effects and interactions with state parity laws in the overall sample and racial/ethnic subgroups.
RESULTS
While we found no significant main effects of federal parity on alcohol treatment rates, there was a significantly greater increase in treatment rates in states requiring health plans to cover alcohol treatment and having some pre-existing parity. This was seen overall and in all three racial/ethnic groups (increasing by 25% in whites, 26% in blacks, and 42% in Hispanics above the expected treatment rate for these groups). Post-MHPAEA, the alcohol treatment admissions rate in these states rose to the level of states with the strongest pre-existing parity laws.
CONCLUSION
The MHPAEA was associated with increased alcohol treatment rates for diverse racial/ethnic groups in states with both alcohol treatment coverage mandates and some prior parity protections. This suggests the importance of the local policy context in understanding early effects of the MHPAEA.
背景
美国心理健康和平等法案（MHPAEA）是一项具有里程碑意义的联邦政策，旨在增加物质使用治疗的可及性，但研究发现，该政策对治疗利用率的影响相对较弱。本研究考虑了是否存在先前存在的州平等法律和不同种族/族裔群体之间治疗率差异变化的调节作用。
方法
我们分析了来自 SAMHSA 的治疗期数据集中 1999 年至 2013 年的数据，评估了具有异质、先前存在的平等法律的各州的酒精治疗入院率变化。NIAAA 的酒精政策信息系统数据用于根据各州在保险覆盖酒精治疗和平等方面的现有和强制程度将各州分为五组（弱；无覆盖无平等；如果提供覆盖则部分平等；覆盖和部分平等；强）。回归模型包括州固定效应和一个三次时间趋势，调整了州和年水平的协变量，并在总体样本和种族/族裔亚组中评估了 MHPAEA 的主要影响及其与州平等法律的相互作用。
结果
虽然我们没有发现联邦平等对酒精治疗率有显著的主要影响，但在要求健康计划覆盖酒精治疗并具有一些先前存在的平等的州，治疗率的增加显著更大。这在总体上和所有三个种族/族裔群体中都有体现（白人增加 25%，黑人增加 26%，西班牙裔增加 42%，高于这些群体的预期治疗率）。在 MHPAEA 之后，这些州的酒精治疗入院率上升到具有最强先前平等法律的州的水平。
结论
MHPAEA 与具有酒精治疗覆盖授权和一些先前平等保护的州的不同种族/族裔群体的酒精治疗率增加有关。这表明了解 MHPAEA 的早期影响时，当地政策环境的重要性。
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