Schoenbaum M, Zhang W, Sturm R
Rand Corporation, Santa Monica, CA 90407, USA.
Psychiatr Serv. 1998 Dec;49(12):1573-8. doi: 10.1176/ps.49.12.1573.
Cost and utilization patterns of substance abuse and mental health treatment under private, employer-sponsored, managed behavioral health care plans were examined.
Data were from claims made in 1995 in 93 behavioral health care plans covering 617,133 members. Rates of use of mental health and substance abuse care were determined, as were payments by insurers and patients for the two types of care. Means were calculated per plan member and per user of either of these service types.
Approximately .3 percent of plan members used any substance abuse services; 5.2 percent used mental health services. However, among substance abuse patients, average costs were more than twice as high as average costs for mental health patients. For substance abuse treatment, the annual cost per user was $2,188, compared with $979 for users of mental health care. Annual per-member costs were $6.51 for substance abuse treatment and $50.08 for mental health care. Higher costs for substance abuse treatment reflected greater rates of use of both inpatient and intensive outpatient treatment. Overall, substance abuse costs represented 13 percent of insurance payments for behavioral health care and perhaps .4 percent of the cost of health insurance overall.
Substance abuse coverage accounts for a small fraction of insurance payments for behavioral health coverage and a very small fraction of insurance payments for both physical and behavioral health care.
研究在私人雇主赞助的管理式行为健康护理计划下，药物滥用和心理健康治疗的成本及使用模式。
数据来自1995年93个行为健康护理计划中的理赔记录，这些计划覆盖617,133名成员。确定了心理健康和药物滥用护理的使用率，以及保险公司和患者对这两种护理的支付情况。计算了每个计划成员以及这两种服务类型中任何一种的使用者的均值。
约0.3%的计划成员使用了任何药物滥用服务；5.2%的成员使用了心理健康服务。然而，在药物滥用患者中，平均成本是心理健康患者平均成本的两倍多。对于药物滥用治疗，每位使用者的年度成本为2,188美元，而心理健康护理使用者为979美元。药物滥用治疗的年度人均成本为6.51美元，心理健康护理为50.08美元。药物滥用治疗成本较高反映出住院和强化门诊治疗的使用率更高。总体而言，药物滥用成本占行为健康护理保险支付的13%，可能占总体健康保险成本的0.4%。
药物滥用保险在行为健康保险支付中占比很小，在身体和行为健康护理保险支付中占比极小。
