title: The impact of managed care on substance abuse treatment: a report of the American Society of Addiction Medicine.
abstract: This report examines the impact of managed care (MC) and related developments on substance abuse treatment, and evaluates how it has been associated with a decline in the availability of proper treatment for many addicted patients. A trend toward carve-out and for-profit MC organizations is associated with lower financial incentives for intensive treatment than in earlier staff-model and not-for-profit MC organizations. The value of substance abuse insurance coverage has declined by 75% between 1988 and 1998 for employees of mid-to large-size companies, compared with only an 11.5% decline for general health insurance. The shift towards MC has also been associated with a drastic reduction in frequency and duration of inpatient hospitalization, and there is no clear evidence that this reduction has been offset by a corresponding increase in outpatient support. In a survey of physicians treating addiction, the majority felt that MC had a negative impact on detoxification and rehabilitation, and on their ethical practice of addiction medicine.
authors.forename: M
authors.initials: M
authors.lastname: Galanter
authors.forename: D S
authors.initials: DS
authors.lastname: Keller
authors.forename: H
authors.initials: H
authors.lastname: Dermatis
authors.forename: S
authors.initials: S
authors.lastname: Egelko
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D008329:Managed Care Programs / Q000191:economics; D008605:Mental Health Services / Q000191:economics / Q000600:supply & distribution; D019966:Substance-Related Disorders / Q000191:economics / Q000628:therapy*