Penn State College of Nursing, University Park, PA 16802, USA.
Division of Biostatistics, College of Public Health, The Ohio State University, USA.
Int J Drug Policy. 2022 Feb;100:103530. doi: 10.1016/j.drugpo.2021.103530. Epub 2021 Nov 24.
Many states in the U.S. still have Alcohol Exclusion Laws (AELs), which allow insurance companies to deny health claims resulting from alcohol impairment. There are concerns that this form of structural stigmatization affects alcohol treatment-seeking behaviors. We examined the effects of AEL repeal on treatment admissions for alcohol use disorder (AUD).
Data on alcohol treatment admissions from 1992 to 2017 were obtained from the Treatment Episode Data Set. The state-level aggregate number of treatment admissions was derived, including healthcare professional referrals only, self-referrals only, and both self-referral and healthcare professional referrals. The number of treatment admissions by health insurance status (private, public, and uninsured) was also calculated. The study used a difference-in-differences (DID) quasi-experimental design.
The DID analysis showed that the number of admissions for alcohol treatment from healthcare professional referrals increased 16% in the AEL repeal states compared to states with AELs or that never had AELs (IRR=1.16, 95% CI=1.07, 1.25). These results were consistent for analysis by payment sources. In particular, treatment admissions from healthcare professional referrals for patients covered by private insurance increased about 38% in states with AEL repeal (IRR=1.38, 95% CI=1.17, 1.64) compared to states without AEL repeal. However, the findings were no longer significant when the state-specific time trends were taken into account.
This study documented that AEL repeal may have had a significant impact on the number of treatment admissions for AUD. These findings suggest that AELs function as a barrier to treatment-seeking behavior.
美国许多州仍有酒精排除法（AEL），允许保险公司拒绝因酒精损害而提出的健康索赔。有人担心这种形式的结构性污名将影响寻求酒精治疗的行为。我们研究了 AEL 废除对酒精使用障碍（AUD）治疗入院的影响。
从 1992 年至 2017 年的治疗期数据集获得了酒精治疗入院的数据。得出了按州划分的治疗入院总数，包括仅由医疗保健专业人员转介、仅自我转介以及自我转介和医疗保健专业人员转介。还计算了按健康保险状况（私人、公共和无保险）划分的治疗入院人数。该研究使用了差异中的差异（DID）准实验设计。
DID 分析表明，与有 AEL 或从未有过 AEL 的州相比，AEL 废除州中由医疗保健专业人员转介的酒精治疗入院人数增加了 16%（IRR=1.16，95%CI=1.07，1.25）。这些结果在按付款来源进行分析时是一致的。特别是，在 AEL 废除的州，由私人保险覆盖的患者的医疗保健专业人员转介治疗入院人数增加了约 38%（IRR=1.38，95%CI=1.17，1.64）与没有废除 AEL 的州相比。然而，当考虑到州特定的时间趋势时，这些发现不再显著。
本研究记录了 AEL 废除可能对 AUD 治疗入院人数产生了重大影响。这些发现表明，AEL 作为寻求治疗行为的障碍。
