An evaluation of substance misuse treatment providers used by an employee assistance program.
Structural measures of access, continuity, and quality of substance misuse treatment services were compared in 30 fee-for-service (FFS) facilities and nine health maintenance organizations (HMOs). Probit models related effects of the provider system (FFS or HMO) and the system's structural characteristics to 243 employees' access to and outcomes from treatment. Access was decreased in Independent Practice Association (IPA)/network HMOs and in all facilities which did not employ an addictionologist or provide coordinated treatment services. When bivariate correlations were examined, both use of copayments and imposing limits to the levels of treatment covered were negatively related to access, while a facility's provision of ongoing professional development was positively associated with access. These correlations did not remain significant in the multivariate probits. Receiving treatment in a staff model HMO and facing limits to the levels of treatment covered were negatively associated with attaining sufficient progress, while receiving treatment in a facility which provided ongoing professional development was positively related to progress: these effects did not remain significant in multivariate analyses. Implications for employee assistance program (EAP) staff in their role as case managers and for EAP staff and employers in their shared role as purchasers of treatment are discussed.
Miller
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Office of Research and Demonstrations, Health Care Financing Administration, Baltimore, Maryland 21207.
D000328:Adult; D001294:Attitude to Health; D003695:Delivery of Health Care / Q000191:economics; D004651:Employment; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics / Q000592:standards*; D006282:Health Personnel / Q000592:standards; D006297:Health Services Accessibility; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D009786:Occupational Health Services / Q000592:standards*; D044469:Racial Groups; D012737:Sex Factors; D016320:Substance Abuse Treatment Centers / Q000191:economics / Q000592:standards*; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*; D000078329:Workforce