Prevention and Treatment of Alcohol Problems Research Opportunities (1990) / Chapter Skim
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14 Treatment Costs, Benefits, and Cost Offsets: Public Policy Considerations
14 Treatment Costs, Benefits, and Cost Offsets: Public Policy Considerations
Pages 289-308
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From page 289... ...
In the last 20 years, however, a counterinfluence has developed that embodies an equally single-minded perspective in health policy analysis: the exclusive use of economic criteria. Neither of these approaches is sufficient to deal with the complexities of most relevant issues and especially with the policy questions that surround the costs of insurance coverage for alcohol treatment.
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From page 290... ...
They provide guides to the assumptions and estimation methods used in evaluating treatments. More studies like these are needed to answer questions such as the following: What other costs besides total health care costs are reduced by successful alcoholism treatment?
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From page 291... ...
Although Meta-analysis can be useful when properly applied to a series of studies with common outcome measures, the lack of commonly accepted and standardized measures of outcome makes its use somewhat problematic in cost-effectiveness analyses of treatment for alcohol abuse. The use of professional judgments to rate individual studies and to make assessments (even by using explicit criteria)
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From page 292... ...
The costs here are confined to treatment costs, and the effects are limited to reduced medical care utilization, which is sometimes measured in terms of cost savings (Holder, 1987~. Cost offset ideally involves a process whereby the total posttreatment health care costs (including alcoholism treatment)
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From page 293... ...
Cost offset studies suffer from the absence of an explanatory model and from methodological problems similar to those in other health care research. The first relevant question is whether reduced demand for care following treatment is real or artificial, that is, whether the decline can be attributed to the treatment rather than to regression to the mean as has been observed for high utilizers of medical services.
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From page 294... ...
Insofar as such declines are confined to inpatient services, which are largely under the control of physicians or other providers who act as "gatekeepers" to the system, changes may reflect differences over time in HMO or provider policies rather than changes in the need for care from the patient's perspective. Declines in inpatient rates could reflect secular trends rather than treatment effects if calendar dates are used (Putnam, 1982~; however, many cost offset studies use point-of-treatment utilization (Holder and Those, 1986~.
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From page 295... ...
He concluded further that the existing methodological shortcomings do not "prevent reasonable (but perhaps cautious) policy statements about alcoholism treatment and health care costs." He reported that As a group, the studies reviewed confirm the potential of alcoholism treatment to contribute to sustained reductions in total health care utilization and costs.
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From page 296... ...
Review procedures include a hospital preadmission review, continued-stay review, mandated second opinion programs, discharge planning, major case management, and alternate service recommendations. The procedures may be managed by a peer review organization, a health insurance company staff, or private case management companies.
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From page 297... ...
An assortment of services can be covered under insurance, including inpatient detoxification, residential treatment, partial hospitalization, extended or long-term care, and outpatient care. However, in the past, alcoholism treatment services have generally been excluded from coverage or covered under sharply limited mental health treatment services.
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From page 298... ...
The most recent study of how cost sharing affects the utilization of specialized treatment services was the Rand health insurance study (Manning et al., 1986~. This study, which dealt only with mental health and not with alcoholism treatment services, used a randomized design and enrolled more than 5,800 people.
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From page 299... ...
· More systematic studies are needed of the effect of insurance coverage and cost factors on the utilization of alcoholism treatment services. OTHER COST-RELATED RESEARCH AREAS One important policy question concerns the role that should be played by public and private financing for alcoholism treatment.
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From page 300... ...
The following are opportunities for research on issues in the utilization of adolescent treatment for alcohol problems: · The factors that may influence adolescents' use of treatment services for alcohol and drug abuse should be studied, as should the relationship between the utilization of treatment seduces and the need for care. · The insurance issues relative to adolescent care should be studied; for example, how does variation in copayment rates and levels of benefits affect the utilization of treatment services?
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From page 301... ...
Collins, T., and M Lute An evaluation of the Fairview Deaconess Hospital Adolescent Chemical Dependency Program.
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From page 302... ...
Effect of coverage on use of an HMO alcoholism treatment program, outcome, and medical care utilization.
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From page 303... ...
Impact of alcohol, drug abuse and mental health treatment on medical care utilization: A review of the research literature.
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From page 304... ...
National Institute on Alcohol Abuse and Alcoholism. Health insurance coverage for alcoholism treatment.
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From page 305... ...
S Meta-analysis of 143 adolescent drug prevention programs: Quantitative outcome results of program participants compared to a control or comparison group.
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From page 308... ...
Chapter 15 examines federal support for the scientific infrastructure for prevention research, and Chapter 16 explores similar issues for treatment research.
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