tients who are likely to have greater treatment needs. However, there is little published information about the most elementary characteristics of managed drug abuse treatment, such as staff-client ratios, staff training, and frequency and duration of services. Even less is known about the impact on patient care of financial incentives to curtail costs. Finally, although managed behavioral health care organizations appear to be increasingly willing to publish their patient placement criteria, little is known about whether these criteria are actually adhered to by those responsible for making placements. Thus, there is a need to undertake studies of the organization, financing, and characteristics of managed drug abuse care.

The committee recommends that the appropriate federal agencies (e.g., the Substance Abuse and Mental Health Services Administration [SAMHSA], the Health Care Financing Administration [HCFA], the National Institute on Drug Abuse [NIDA], and the National Institute on Alcohol Abuse and Alcoholism [NIAAA]) and private organizations undertake studies of the organization, financing, and characteristics of drug abuse treatment in the managed care setting, including variations in the content, intensity, continuum of care, and duration of treatment as they relate to patient needs.

Particular attention needs to be given to well-controlled studies of patient outcomes for private and public sector patients, credentials of gatekeepers, accountability systems, and patient placement criteria.


Access, Costs, and Utilization

Four major studies have examined the impact of managed care on access to drug abuse treatment, cost of treatment, and utilization of services. All four were conducted in naturalistic, nonexperimental settings, and three of the four examined Medicaid populations (Table 9.2). These studies were methodologically diverse and examined various models of managed care, but all four compared managed care with unmanaged care and/or alternative models of managed care—the kinds of comparisons that are most compelling for those responsible for choosing among different managed and unmanaged plans for their beneficiaries.

In 1992, Massachusetts instituted a privately contracted managed care program for Medicaid patients. Research on this program documented a 48 percent reduction in drug abuse treatment expenditures per enrollee in the first year of the program, compared with the prior year's fee-for-

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