Broadening the Base of Treatment for Alcohol Problems (1990) / Chapter Skim
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Chapter 8--Who pays for treatment?
Chapter 8--Who pays for treatment?
Pages 183-210
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From page 183... ...
Traditionally, financing for the treatment for alcohol problems was seen as belonging under the rubric of mental health services and as such has suffered from the same negative, stigmatizing perceptions of health insurers, employers, and the community at large that have bedeviled mental health funding (Sharfstein et al., 1984~. It was not until the early 1960s that a movement developed for separate funding mechanisms and organizations for treatment of mental disorders, alcohol problems, and drug abuse problems (Plaut, 1967; President's Commission on Mental Health, Task Panel on Alcohol Related Problems, 1978; J
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From page 184... ...
Treatment for alcohol problems is still considered to belong in the Nervous and mental disorders" category by most public and private health third-party payers, including Medicaid and Medicare, a policy that creates difficulties in obtaining data on actual expenditures and in developing an independent body of research on financing and its relation to practice (Burton, 1984; Sharfstein et al., 1984; Muszynski, 1987~. There is no single survey currently in use that captures data on the amount of money being spent for the treatment of alcohol problems (Musynski, 1987; Robertson, 1988~.
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From page 185... ...
There is an increasing trend, however, to combine under the substance abuse/chemical dependency rubric the funding and organization of services for persons experiencing problems with alcohol with services for persons experiencing problems with other drugs (Butynski and Record, 1983~. One of the difficulties created by this combination is the failure to obtain reporting from the states on their distribution of both state funds and federal alcohol, drug abuse, and mental health services block grant funds that are specifically earmarked for the treatment of alcohol problems.
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From page 186... ...
. Agencies that provide block grant funding are the Alcohol, Drug Abuse, and Mental Health Administration and the Office of Human Services.
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From page 187... ...
Third-party payers can also be differentiated in terms of which components of treatment they will pay for. Public and private health insurers clearly confine their benefits to services that are identified as medical and that meet specific standards of medical necessity.
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From page 188... ...
, and three are federal government sources TABLE 8-1 Sources of Funding for Specialty Units Providing Treatment for Alcohol Problems in 1982 and 1987, Based on Data from the National Drug and Alcoholism Treatment Unit Survey (in thousands of dollars) Funding Sources 1982 1982 1987 1987 Amount Percentage Amount Percentage State government program funds 235,751 21.1345,023 20.2 Local government program funds 108,254 9.6107,660 6.3 State/local government fees for service 45,413 4.078,830 4.6 Public welfare 18,257 1.627,778 1.6 Public health insurance 77,922 6.9145,746 8.5 Alcohol, drug abuse, and mental health block grant 50,910 4.5N/Aa Social services block grant 13,959 1.2N/Ab Other ADAMHA support 12,133 1.19,440 0.6 Other federal funds 112,456 10.076,957 4.5 Private health insurance 296,419 26.4592,470 34.6 Private donations 28,754 2.626,906 1.6 Client fees 110,272 9.8236,531 13.8 Other 12,677 1.164,752 3.8 Total 1,123,175C 100.01,712,069 100.0 SOURCE: NIAAA (1983)
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From page 189... ...
. The nongovernmental sources include private health private donations (2 percent)
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From page 190... ...
General Accounting Office, 1985~. The alcohol, drug abuse, and mental health services block grant consolidated the formula grant and project grant and contract programs administered by the National Institute on Alcohol Abuse and Alcoholism with similar programs administered by the National Institute on Drug Abuse and the National Institute of Mental Health.
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From page 191... ...
The table shows that in 1982 and 1987 state government program funds, including the alcohol, drug abuse, and mental health services block grant, were the second largest single source of funds: 20 percent of the total revenues in 1987. It seems appropriate to combine the four categories used for state and local funds because they are primarily alternative methodologies for distributing funds (e.g., program budgets and fees for service; matching funds)
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From page 192... ...
As noted on Table 8-1, the information previously reported separately for the alcohol, drug abuse, and mental health services block grant has been combined with the state government program funds category and the information on the social services block grant (formerly Title XX) has been combined with the public welfare category.
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From page 193... ...
The hospital treatment of alcohol problems under Medicare is included in the general category of psychiatric health services along with mental disorders and drug abuse; in contrast to Medicare's more liberal benefit available for physical illnesses, coverage for inpatient care within a psychiatric hospital is limited to 190 lifetime days. The 190-day lifetime limit on inpatient psychiatric hospital services was originally included in the Medicare benefit design to ensure that only active treatment under a physician's supervision and evaluation and not Custodial caret- would be covered.
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From page 194... ...
Medicaid does not necessarily provide coverage for the educational, vocational, and psychosocial services that are considered by most treatment providers and state alcoholism agencies as an essential part of rehabilitation and maintenance (relapse prevention)
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From page 195... ...
Five states, with 34 percent of the nation's total population, alone accounted for 63 percent of the private health insurance reimbursement. California, which had the largest number of programs reporting, itself accounted for 42 percent of the total private health insurance reimbursement.
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From page 196... ...
In 1982 ownership was a significant factor: private nonprofit providers reported that 30 percent of their funding came from private health insurance, private for-profit units reported 67 percent from private insurance, and units operated by state and local governments reported 16 percent (NIAAA, 1983: Table 15~. The 1987 NDATUS data also suggest that the various sources of funding are concentrated in specific types of organizations and care.
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From page 197... ...
, on behalf of the Department of Health and Human Services (Butynski et al., 1987; Butynski and Canova, 1988~. The survey was initiated in 1982 with the advent of federal alcohol, drug abuse, and mental health services block grant funding as a replacement mechanism for obtaining information on financing that had previously been gathered by NIAAA through its State Alcohol Profile Information System (SAPIS)
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From page 198... ...
The SADAP data are collected for six very broad categories of funds and do not disaggregate the amounts received from such major sources as patient payments, type of health insurance (e.g., private, public, Medicare, Blue Cross, HMO, Medicaid) , and other government agencies (e.g., the social services block grant, vocational rehabilitation, county general funds)
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From page 199... ...
1985, 1986, and 1987 for Expenditures in State AlcohoVDrug Abuse Agengy-Supponed Programs, Based on Data Collected in the State Alcohol and Drug Abuse Profile (in percent) Source of FundsBY 1985 FY 1986 FY 1987 State alcohol/drug agencies48 46 46 Other state agencies4 6 6 AlcohoVdrug abuse/mental health block grants17 16 15 Other federal sources3 3 3 County/local agency6 9 9 Other (fees, insurance, etc.)
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From page 200... ...
is the trade association to which many specialty programs belong (Ford, 1988~. In a 1986 survey of almost 11,000 patients discharged from 230 member inpatient treatment facilities, NAATP found that more than 67 percent of the patients were covered by a private health insurance plan (ICE, Inc., 1987~.
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From page 201... ...
In the table the federal role is somewhat understated for the specialist treatment of alcohol problems because the data come from the 1987 NDATUS in which federal block grants were included as state contributions. (The specific contribution of the several block grants is unknown because there is no other source that tracks block grant funds used for the treatment of alcohol problems.)
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From page 202... ...
Source of Funds Alcohol Problemsa All Health Careb State/local governments 33 8 Federal government 5 7 Private health insurance 35 32 Public health insuranced 8 27 Direct patient payments 14 25 Private donations/other 5 2 Total 100.0 lOl.Oe aData taken from the IOM analysis of the 1987 NDATUS (NIDA/NIAAA, 1989)
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From page 203... ...
For alcohol dependence the average charge per episode was $3,768 for an average length of stay of 11.9 days and an average per diem charge of $317. For alcohol abuse the average charge per episode was $2,897 for an average length of stay of 9.9 days and an average per diem charge of $292.
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From page 204... ...
The 1989 directory of Minnesota chemical dependency programs yielded an average cost of $146 per day for detoxification, $184 per day for primary rehabilitation, $97 per day for extended care, and $24 for outpatient treatment (Minnesota Chemical Dependency Program Division, 1989~. Again, there is a lack of systematically collected data about the costs of treatment on a national basis for use in policymaking.
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From page 205... ...
Although the proportion of funding provided by private health insurance has grown substantially, the largest source of total funding for the treatment of alcohol problems continues to be public funds (state, county, or local general fund revenues or dedicated taxes and fees; federal block grants; federal health insurance mechanisms in the form of Medicare, Medicaid, and CHAMPUS; or federal direct services through the Department of Defense, Indian Health Services, Veterans Administration, and Bureau of Prisons)
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From page 206... ...
1979. Private Health Insurance Benefits for Alcoholism, Drug Abuse, and Mental Illness.
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From page 207... ...
Davis, K 1987. The organization and financing of alcohol and drug abuse services.
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From page 208... ...
Prepared for the National Institute on Alcohol Abuse and Alcoholism. Rockville, Md.: Alcohol, Drug Abuse, and Mental Health Administration.
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From page 209... ...
S Senate Committee on Governmental Affairs hearing regarding an overview of federal activities on alcohol abuse and alcoholism, National Association of State Alcohol and Drug Abuse Directors, Washington, D.C., May 25.
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From page 210... ...
1984. States Have Made Few Changes in Implementing the Alcohol, Drug Abuse, and Mental Health Services Block Grant.
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