New directions in alcohol and drug treatment under managed care.
OBJECTIVE
To examine the potential effects of the introduction and expansion of managed care on the financing and organization of public and private alcohol and drug abuse treatment systems by reviewing studies on managed care and substance abuse.


METHODS
Spending on treatment for alcohol and drug abuse, the organization of treatment, treatment workforce composition, provision of services, and their implications for access and treatment outcome were examined by review of the treatment literature.


RESULTS
Managed care has had major effects on the organization of service delivery, the workforce, and the provision of services. Most of the changes have occurred without the benefit of clinical or policy research. Although managed care has the potential ability to address longstanding problems associated with alcohol and drug treatment, it also presents additional barriers to access and improving treatment outcome.


CONCLUSIONS
The review suggests that organizational approaches, particularly the settings in which treatment is placed, will differ in their impact on ties between treatment agencies and the medical community, and ties with other health and social service agencies. Also of importance is a new emphasis on accountability of treatment through the mechanisms of outcomes monitoring and performance indicators. It remains to be seen whether these innovations will be meaningfully linked with outcomes research. It is incumbent on researchers and clinicians to explore these issues.
Weisner
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C
Alcohol Research Group and School of Public Health, University of California, Berkeley 94709, USA. cweisner@arg.org
McCarty
D
D
Schmidt
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L
D000437:Alcoholism / Q000191:economics / Q000534:rehabilitation*; D003284:Contract Services; D019468:Disease Management; D006297:Health Services Accessibility; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration* / Q000592:standards; D008605:Mental Health Services / Q000191:economics / Q000458:organization & administration / Q000639:trends*; D017063:Outcome Assessment, Health Care; D017149:Private Sector; D011357:Product Line Management; D017150:Public Sector; D019966:Substance-Related Disorders / Q000191:economics / Q000534:rehabilitation*; D014481:United States; D014600:Utilization Review