Alcoholism treatment offset effects: an insurance perspective.

This study investigates whether alcoholism treatment costs are offset by reductions in other medical treatment costs by comparing people treated for alcoholism with a matched comparison group. The alcoholism treatment group is defined by diagnoses of alcohol dependence, abuse, or psychoses from health insurance claims field between January 1980 and June 1987. A comparison sample was matched on age, gender, and insurance coverage. In this primarily methodological study, expected costs for nonalcoholism treatments were calculated from standardized regressions. Offset effects were measured from the insurer's perspective through differences in expected total nonalcoholism treatment costs in the periods preceding and following alcoholism treatment. Members of the alcoholism treatment group were more likely than the comparison group to be hospitalized and to need other (nonalcoholism) medical treatment, thus incurring higher total costs. Offset effects emerged for patients with alcohol abuse and without mental psychosis comorbidities.

Short term drug abuse treatment costs and utilization: a multi-employer analysis.

OBJECTIVES: This report investigates three aspects of drug abuse treatment costs, with special emphasis on systematic differences among employers: (1) predictors of drug abuse treatment costs; (2) differentials in drug abuse treatment costs across employers; and (3) differential impacts of patient and employer characteristics on drug abuse treatment costs. METHODS: The study used multiple regression analysis of behavioral cost functions. It decomposed cost differences into employer and variable effects using an algebraic method that accounted for differences in cost functions and in population characteristics. An insurance claims database was used from 10 large self-insured employers for a 3-year period starting January 1989. RESULTS: Marginal inpatient costs generally exceeded average costs, leading to slightly increasing costs per day as length of stay increased. Marginal outpatient costs were generally about the same as average costs, implying that outpatient drug treatment maintained constant unit costs as utilization increased. Decomposition of cost differences among employers suggested that observed differences among employers and/or their carriers (who administer the benefits for the self-insured employers) and providers appeared to be at least as important as differences among the characteristics or the utilization of the people that they cover. CONCLUSIONS: National health policies aimed at reducing costs are likely to have differing impacts on different employers. Employers with high costs relative to the characteristics of their covered population may be able to achieve significant cost savings. Employers serving populations with greater risk factors may find it difficult to cut costs further.

A discrete choice model of drug abuse treatment location.

OBJECTIVE: To identify short-term drug abuse treatment location risk factors for ten large, self-insured firms starting January 1, 1989 and ending December 31, 1991. DATA SOURCES/STUDY SETTING: Study population selected from a large database of health insurance claims for all treatment events starting January 1, 1989 and ending December 31, 1991. STUDY DESIGN: A nested binomial logit method is used to estimate firm-specific patterns of treatment location. The differences in treatment location patterns among firms are then decomposed into firm effects (holding explanatory variables constant among firms) and variable effects (holding firm-specific parameters constant). PRINCIPAL FINDINGS: Probability of inpatient drug treatment is directly related to the type of drug diagnosis. The most important factors are diagnoses of drug dependence (versus drug abuse) and/or a cocaine dependence. Firm-specific factors also make a substantive difference. Controlling for patient risk factors, firm-specific probabilities of inpatient treatment vary by as much as 87 percent. Controlling for practices of firms and their insurance carriers, differing patient risk profiles cause probabilities of inpatient treatment to vary by as much as 69 percent among firms. Use of the outpatient setting increased over the three-year period. CONCLUSIONS: There are two plausible explanations for the findings. First, people beginning treatment later in the three-year period had less severe conditions than earlier cases and therefore had less need of inpatient treatment. Second, drug abuse treatment experienced the same trend toward the increased use of outpatient care that characterized treatment for other illnesses in the 1980s and early 1990s.

Cost and usage impacts of treatment initiation: a comparison of alcoholism and drug abuse treatments.

An extensive literature on substance abuse and mental health treatments suggests that they often lead to decreased usage and/or spending on other medical treatments. We compare alcohol and drug abuse treatment costs with a model that decomposes total treatment costs into amount of treatment (outpatient visits or inpatient days) and costs per treatment. The analysis compares alcohol and drug abuse treatment costs regarding: (1) the incremental costs attributable to changed short-term substance abuse and nonsubstance abuse treatments; (2) the impacts of current substance abuse treatments on short-term nonsubstance abuse, long-term substance abuse, and long-term nonsubstance abuse treatments; and (3) the difference in inpatient and outpatient impacts. Our findings indicate that alcoholism and drug abuse treatment initiation have similar impacts on coincident and subsequent utilization and costs. For both treatments, the largest portions of the cost impacts occur for inpatient treatments, and for treatments that occur within 6 months of the initiation. The similarity of results suggests that it may often be reasonable to infer utilization and cost impacts for one type of care from studies that examine the other.

A discrete choice model of alcoholism treatment location.

In this study, a discrete choice model of alcoholism treatment location, with special emphasis on the roles of comorbidities is considered. Three specific questions are addressed: 1) what demographic and health factors have significant impacts on treatment location for both short- and long-term alcoholism and nonalcoholism treatments?; 2) how does the impact of alcohol dependence differ from the impact of alcohol abuse, on probabilities of short-term or long-term inpatient treatment?; and 3) what are the impacts of health comorbidities on probabilities of inpatient treatment in the short or long term? A binomial logit model is estimated for short- and long-term alcoholism treatment, as well as for short- and long-term nonalcoholism treatment (which occurs at the same time). The results indicate the importance of comorbidities in predicting treatment location. They also indicate a trend during the 1980s toward increased use of outpatient rather than inpatient treatment.

An analysis of short-term alcoholism treatment cost functions.

A number of alcohol treatment studies have documented variations in the average cost of treating alcoholics. However, these studies have provided little explanation for these variations. In this study, three major issues in the measurement of alcoholism treatment costs are investigated: 1) choice of treatment location, i.e., inpatient versus outpatient; 2) interaction of treatment locations in the estimation of costs; 3) impact of type of alcohol problem and comorbidities on treatment costs. The study includes an integrated framework that jointly estimates treatment location and treatment costs conditional on treatment location, concentrating on short-term alcoholism treatment and using insurance claims data to specify a 6-month period beginning with each individual's first treatment for alcoholism. The different treatment types subsumed in the categories alcohol abuse and alcohol dependence are also addressed. Results indicate that comorbidities are crucial in determining treatment location. Once treatment location is determined, however, their effects on treatment costs, while measurable, are statistically insignificant. Partial treatment effects, conditional on treatment location, differ substantially from full treatment effects, which are determined jointly with treatment location.

Alcoholism treatment offset effects: a cost model.

Alcoholism treatment (AL) changes usage and/or spending on non-alcoholism treatment (NA). Yet there has been little economic analysis of the effect of AL on individuals' uses of health services and total health care costs. Our model yields both cost and usage impacts. A 1% increase in short-term AL events implies a 1.9% increase in costs; subsequent AL increases costs by .6%. A 1% increase in short-term NA events implies a 1.3% increase in costs; subsequent NA increases costs by 1.5%. Initiation of AL directly lowers NA, but indirectly increases NA usage (and hence, costs) in subsequent treatment. Overall, a 10% increase in AL leads to a 9.2% increase in health care costs.

Sickle cell trait counseling-evaluation of counselors and counselees.

In this study, information about both counselee and counselor performance was obtained from taped recordings of 193 structured counseling sessions with persons diagnosed as having sickle cell trait. The data provide evidence that: (1) lay persons can understand essential sickle cell information; (2) trained lay persons using a structured format can transmit successfully sickle cell information; (3) only education and age, among counselee characteristics studies, were related to successful learning; (4) the evaluation of information transfer in counseling programs cannot be limited to counselees' comprehension but must also consider other variables such as counselor performance and curriculum content; (5) a reduction in negative feelings associated with a diagnosis of sickle cell trait is an immediate effect of counseling; and (6) audio-taping of counseling sessions is client acceptable and useful for evaluation, quality control, and counselor training.

Screening for psychosocial problems in health settings.

Providing comprehensive care requires identifying the total range of social, psychological, and medical needs that patients present to their health care providers. This study compares two approaches used to screen people for psychosocial problems in a hospital clinic. Findings suggest that a method in which clients identify their own problems yields different results from an alternative method in which professionals identify problem areas.