Treating Drug Problems Volume 1 (1990) / Chapter Skim
Currently Skimming:
6 Two Tiers: Public and Private Study
6 Two Tiers: Public and Private Study
Pages 200-219
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 200... ...
These individual concerns, repeated across hundreds of thousands of cases a year, cast a large question mark over the size, distribution, structure, and efficiency of the treatment supply system. For analysts, these questions are articulated somewhat differently.
|
From page 201... ...
This tier is growing rapidly, and the total revenues received by its providers are beginning to approach the total revenues of providers in the public tier. Within the private tier, the
|
From page 202... ...
Nevertheless, the tiers are sharply distinguishable in data collected in the 1987 National Drug and Alcoholism Treatment Utilization Survey, or NDATUS.i The axis that most clearly divides the two tiers of treatment is source of revenue. Closely correlated with these tiers are radically higher levels of reimbursements for private clients, modest differences in the nature and richness of delivered care, and disparities in accessibility of services, with a much greater chance that applicants to the private tier can gain immediate admission to treatment.
|
From page 203... ...
Source: Institute of Medicine analysis of the 1987 National Drug and Alcoholism Treatment Utilization Survey. Not-for-profit organizations are in the middle but are clearly differentiated by type of facility.
|
From page 204... ...
1,312 521 791 Revenue per admission 1,550 2,450 1,240 Facilities 5,121 1,275 3,846 Hospitals 960 801 159 Residential 990 76 914 Outpatient 2,765 331 2,434 Methadone 334 67 267 Corrections 72 0 72 Clients per counselor Inpatient 9.1 7.2 9.7 Outpatient 38.5 37.3 38.8 Outpatient appointments/week 1.7 1.9 1.65 Source: Institute of Medicine analysis of the 1987 National Drug and Alcoholism Treatment Utilization Survey. Data were provided by the National Institute on Drug Abuse.
|
From page 205... ...
Source: Institute of Medicine analysis of the 1987 National Drug and Alcoholism Treatment Utilization Surveyor. Client Differences Compared with private-tier clients, public clients have longer histories of drug taking, are more likely to have taken more types of drugs, are less likely to be employed or engaged in other socially conventional activities, are more likely to have major social deficits (e.g., education)
|
From page 206... ...
Capacity utilization varies by type of program and by tier. In general, there is considerable excess capacity throughout the private tier and much less in the public tier.
|
From page 207... ...
Source: Institute of Medicine analysis of the 1987 National Drug and Alcoholism Treatment Utilization Survey. declined to 68,000 in 1980, and increased to 72,000 in 1982 and to 82,000 in 1987.
|
From page 208... ...
Sources: National Institute on Drug Abuse (197~1980, 1983a) and Institute of Medicine analysis of the 1987 National Drug and Alcoholism Treatment Utilization Survey.
|
From page 209... ...
programs, 330 methadone maintenance outpatient programs, and 72 correctional facilities with specialty drug treatment programs completed the drug abuse treatment system. The total enrollment of 263,000 persons in 1987 was 50 percent greater than in 1982, although only 20 percent larger than in 1976, the first year of the NDATUS.
|
From page 210... ...
Sources: National Institute on Drug Abuse (1976-1980, 1983a) ; Institute of Medicine analysis of the 1987 National Drug and Alcoholism Treatment Utilization Survey.
|
From page 211... ...
; Institute of Medicine analysis of the 1987 National Drug and Alcoholism Treatment Utilization Survey.
|
From page 212... ...
Source: For 197~1980, data were taken from the National Institute on Drug Abuse reports of data from the National Drug and Alcoholism Treatment Utilization Survey (National Institute on Drug Abuse, 197~1980)
|
From page 213... ...
. Source: Institute of Medicine analysis of the 1987 National Drug and Alcoholism Treatment Utilization Survey.
|
From page 214... ...
. Source: Nominal drug expenditure data from the Strategy Council on Drug Abuse (1975 and later yeam)
|
From page 215... ...
for Drug, Alcohol, and Mental Health Treatment Provided Through Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) -Administered Categoncal and Block Grants, 1980-1989 Year 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 (est.)
|
From page 216... ...
CONCLUSION The most important feature of the nation's drug treatment supply system is its very clear division between two tiers of providers that differ in financing, origins, clientele, capacity utilization, and modalities. There is a public tier of mostly outpatient and residential programs for indigent clients, many with serious criminal records and other social deficits, that is about 20 years old; and there is a smaller private tier of mostly hospitalbased programs for middle- and upper-class clients, which is effectively about 10 years old.
|
From page 217... ...
Most private-tier (but relatively little TABLE 6-4 Federal Anti-Drug Abuse Expenditures (in millions of dollars) for Treatment, Prevention, and Cnminal Justice: Obligations for Fiscal Years 1969-1989 Provided in Nominal and Inflation-adjusted Figures Nominal Dollarsa Year Treatment 1969 40 1970 50 1971 80 1972 170 1973 280 1974 310 1975 250 1976 250 1977 260 1978 260 1979 290 1980 270 1981 210 1982 160 1983 180 1984 180 1985 190 1986 190 1987 370 1988 370 1989 520 Criminal Prevention Justice Real 1987 Dollarsb Criminal Treatment Prevention Justice 120 180 260 460 540 640 660 700 670 720 730 770 1,030 1,180 1,370 1,560 1,780 1,830 2,290 2,400 2,460 10 20 50 110 140 160 110 110 110 110 120 140 120 120 140 150 180 190 320 450 680 40 60 90 170 210 280 320 360 370 420 470 550 810 980 1,190 1,420 1,670 1,760 2,290 2,490 2,660 160 190 290 600 950 960 700 620 590 560 560 480 330 230 240 230 220 200 370 340 450 20 70 130 310 350 360 230 210 200 190 190 190 150 150 160 170 190 190 320 440 630 aNominal drug expenditure data are taken from Strategy Council on Drug Abuse (1975 and later years)
|
From page 218... ...
clients among their insured clientele; some programs also began aggressive efforts to reach more such patients as the incidence of alcoholism stopped growing during the 1980s. The extension of alcoholism treatment capacity to drug treatment occurred in the public tier as well and is manifest in the sizable increase in the self-designation of NDATUS treatment units as combined alcohol/drug providers.
|
From page 219... ...
Because methadone maintenance—provided at adequate levels and with supporting services is the most rigorously validated treatment for heroin dependence, there is good reason to put additional resources into this modality in areas of the country where need and demand for it are strongest, keeping in mind the general principle of improving treatment resource intensity in parallel with capacity. The private tier may be capable of offering methadone treatment as efficiently as the public tier, although the scarcity of evaluation research on private-tier methadone treatment warrants serious caution.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.