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Study suggests way to improve managed care of alcoholism treatment

by Paul Dingsdale

A large number of alcoholics go through detoxification programs under managed care, but a significantly greater percentage of those would participate in effective follow-up treatment if their co-payments were reduced, according to a new study conducted by Bradley Stein, assistant professor of psychiatry, and researchers at the RAND Corporation.

It appears in the February issue of Psychiatric Services.

Stein and his colleagues examined data for more than a 1,000 patients from 14 employer groups over seven years from 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, according to Stein.

An estimated five 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 up by additional treatment is effective in long-term care of addicts.

Stein’s study also 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. Co-payments of $20 would result in a 19 percent increase in non-participation, Stein said.

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, Stein said.

This 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 length of time between detoxification discharge and follow-up for managed care patients was relatively brief, with most initial sessions occurring within one week and more than 90 percent occurring within two weeks.

Study suggests way to improve managed care of alcoholism treatment

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