Large numbers of alcoholics go through detoxification programs under managed care, but a significantly greater percentage would participate in effective follow-up treatment if their co-payments were reduced. That's the conclusion of a study conducted by Bradley Stein, M.D, assistant professor of psychiatry at the Keck School of Medicine of the University of Southern California, and published in the February issue of Psychiatric Services.
Stein and colleagues at the RAND Corporation examined data for more than a thousand patients, over seven years, from 14 employer groups at a mid-western managed care company offering behavioral health care benefits.
"It is obvious to expect that lower co-payments would increase participation in effective follow-up treatment, but our study shows that the increase is substantial. Besides, without follow-up treatment, the dollars spent on detoxification alone cannot produce long-term recovery for those with severe addictions," Stein explained.
"Our study showed that almost 79 percent of detoxification patients in managed care received formal substance abuse treatment follow-up, but their participation in these follow-up treatment programs depended on the amount of their co-payments. That suggests there is room for improvement."
An estimated 5 million Americans need drug and alcohol treatment. The first step in the treatment for many is detoxification, which manages withdrawal while helping to remove the toxic substances from an addict's body. Detoxification followed by additional treatment is effective in long-term care of addicts, said Stein.
The USC study shows that managed care patients may be doing better than some others when it comes to substance abuse treatment following detoxification.
The RAND researchers estimated the effect of co-payments of $30, $20, $10 and $0.
"The average co-payment for the patients we studied was $12.30. If co-payments were constant at $30 for all patients, we would see a 43 percent increase in the number of subjects not participating in follow-up," Stein said. "Co-payments of $20 would result in a 19 percent increase in non-participation. On the other hand, zero co-payment would see an increase in participation by 24 percent, and a $10 co-payment would result in a 5 percent increase in participation."
The study also shows that managed care patients receive formal substance abuse treatment following inpatient detoxification at a "substantially higher" rate than that seen in populations that are not insured privately.
The study was funded by the Robert Wood Johnson Clinical Scholars Program, the Robert Wood Johnson Substance Abuse Policy Research Program, the NIMH Faculty Scholars Program and the NIDA.
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Psychiatric Services