Montgomery Barrett Wallace, Aldridge Arnie, Drawbridge Dara, Packer Ira, Vincent Gina M, Rodriguez-Monguio Rosa
RTI International, Research Triangle Park, North Carolina, RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194, United States.
Department of Psychiatry, Center of Excellence for Specialty Courts, University of Massachusetts Medical School, 222 Maple Ave, Chang Building, UMass Chan, Shrewsbury, MA 01545, United States.
Drug Alcohol Depend Rep. 2024 Jul 20;12:100258. doi: 10.1016/j.dadr.2024.100258. eCollection 2024 Sep.
Individuals within the criminal justice system are at greater risk of substance use-related morbidity and mortality and have substantial healthcare needs. In this quasi-experimental study, we assessed utilization patterns of Massachusetts Medicaid Program (MassHealth) services and associated expenditures among drug court probationers compared to a propensity score-matched sample of traditional court probationers. Risk of reoffending, employment status, age, and living arrangement data were used to calculate propensity scores and match probationers between the two court types, producing a final sample of 271 in each court (N=542). Utilization of services and associated expenditures were analyzed using a two-part model to address the skewed distribution of the data and to control for residual differences after matching from the perspective of the payer (i.e., MassHealth). The largest categories of MassHealth spending were prescription pharmaceuticals, hospital inpatient visits, and physician visits. In the unadjusted analysis, drug court probationers exhibited greater MassHealth services utilization and expenditures than traditional court probationers. However, drug courts enrolled more females, more people at higher risk of reoffending, and more people with opioid use disorders. After controlling for differences between the two court types, the difference in MassHealth services utilization and associated expenditures did not reach statistical significance. Drug court probationers were more likely to engage with healthcare services but did not incur significantly greater expenditures than traditional court probationers after controlling for differences between the samples.
刑事司法系统中的个体面临与物质使用相关的发病和死亡风险更高，且有大量医疗保健需求。在这项准实验研究中，我们评估了马萨诸塞州医疗补助计划（MassHealth）服务的使用模式以及药物法庭缓刑人员与传统法庭缓刑人员倾向得分匹配样本相比的相关支出。使用再犯罪风险、就业状况、年龄和居住安排数据来计算倾向得分，并在两种法庭类型的缓刑人员之间进行匹配，最终每种法庭各有271个样本（N = 542）。使用两部分模型分析服务使用情况和相关支出，以解决数据的偏态分布问题，并从付款人（即MassHealth）的角度控制匹配后残留的差异。MassHealth支出的最大类别是处方药、医院住院就诊和医生就诊。在未经调整的分析中，药物法庭缓刑人员比传统法庭缓刑人员表现出更高的MassHealth服务利用率和支出。然而，药物法庭招收了更多女性、再犯罪风险更高的人群以及更多患有阿片类药物使用障碍的人。在控制了两种法庭类型之间的差异后，MassHealth服务利用率和相关支出的差异未达到统计学显著水平。在控制了样本之间的差异后，药物法庭缓刑人员比传统法庭缓刑人员更有可能参与医疗保健服务，但支出并没有显著增加。
