Fox K, Merrill J C, Chang H H, Califano J A
Center on Addiction and Substance Abuse, Columbia University, New York, NY 10019.
Am J Public Health. 1995 Jan;85(1):48-54. doi: 10.2105/ajph.85.1.48.
The purpose of this study was to develop a model, using the epidemiologic tool of attributable risk, for estimating the cost of substance abuse to Medicaid.
Based on prior substance-use and morbidity research, population attributable risks for substance abuse-related diseases were calculated. (These risks measure the proportion of total disease cases attributable to smoking, drinking, and drug use.) The risks for each disease were applied to Medicaid hospital discharges and days on the 1991 National Hospital Discharge Survey that had these diseases as primary diagnoses. The cost of these substance abuse-related days were added to Medicaid hospital costs for direct treatment of substance abuse.
More than 60 medical conditions involving 1100 diagnoses were identified, at least in part, as attributable to substance abuse. Factoring these substance abuse-related conditions into hospital costs, 1 out of 5 Medicaid hospital days, or 4 million days, were spent on substance abuse-related care in 1991. In 1994, this would account for almost $8 billion in Medicaid expenditures.
The use of tobacco, alcohol, and drugs contributes significantly to hospital costs. To address rising costs, substance abuse treatment and prevention should be an integral part of any health care reform effort.
本研究的目的是开发一个模型，利用归因风险这一流行病学工具来估算药物滥用给医疗补助计划带来的成本。
基于先前的药物使用和发病率研究，计算了药物滥用相关疾病的人群归因风险。（这些风险衡量了可归因于吸烟、饮酒和吸毒的疾病病例在总病例中所占的比例。）将每种疾病的风险应用于1991年全国医院出院调查中以这些疾病作为主要诊断的医疗补助计划医院出院病例和住院天数。这些与药物滥用相关的住院天数的成本被加到医疗补助计划用于药物滥用直接治疗的医院成本中。
确定了至少部分可归因于药物滥用的60多种医疗状况，涉及1100种诊断。将这些与药物滥用相关的状况纳入医院成本计算，1991年，五分之一的医疗补助计划医院住院天数，即400万天，用于与药物滥用相关的护理。在1994年，这将占医疗补助计划支出近80亿美元。
烟草、酒精和药物的使用对医院成本有重大影响。为应对不断上升的成本，药物滥用的治疗和预防应成为任何医疗改革努力的一个组成部分。
