Tamara Beetham is a PhD student in health policy and management at Yale University, in New Haven, Connecticut.
Brendan Saloner is the Bloomberg Associate Professor of American Health in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland.
Health Aff (Millwood). 2021 Feb;40(2):317-325. doi: 10.1377/hlthaff.2020.00378.
The use of acute, short-term residential care for opioid use disorder has grown rapidly, with policy makers advocating to increase the availability of "treatment beds." However, there are concerns about high costs and misleading recruitment practices. We conducted an audit survey of 613 residential programs nationally, posing as uninsured cash-paying individuals using heroin and seeking addiction treatment. One-third of callers were offered admission before clinical evaluation, usually within one day. Most programs required up-front payments, with for-profit programs charging more than twice as much ($17,434) as nonprofits ($5,712). Recruitment techniques (for example, offering paid transportation) were used frequently by for-profit, but not nonprofit, programs. Practices including admission offers during the call, high up-front payments, and recruitment techniques were common even among programs with third-party accreditation and state licenses. These findings raise concerns that residential programs, including accredited and licensed ones, may be admitting a clinically and financially vulnerable population for costly treatment without assessing appropriateness for other care settings.
阿片类药物使用障碍的急性短期住院治疗迅速增加，政策制定者主张增加“治疗床位”的供应。然而，人们对高成本和误导性招聘做法表示担忧。我们对全国 613 个住院项目进行了审计调查，以无保险现金支付的海洛因使用者和寻求成瘾治疗的身份进行了调查。三分之一的来电者在临床评估之前获得了入院资格，通常在一天内。大多数项目都需要预先付款，营利性项目的收费是非营利性项目的两倍多（17434 美元）（5712 美元）。营利性项目经常使用招聘技巧（例如提供付费交通），而非营利性项目则不使用。即使在获得第三方认证和州许可证的项目中，也普遍存在包括在电话中提供入院、高额预付款和招聘技巧等做法。这些发现令人担忧的是，住院治疗计划，包括经过认证和许可的计划，可能会在没有评估其他护理环境的适宜性的情况下，为昂贵的治疗而接收临床和经济上脆弱的人群。
