title: Drug and alcohol treatment among privately insured patients: rate of specialty substance abuse treatment and association with cost-sharing.
abstract: OBJECTIVE
  To examine the rate of formal substance abuse (SA) treatment in a privately insured population, and the association between cost-sharing, residential treatment, and outpatient SA treatment, we analyzed claims data for 332442 adults in 41 health plans with comprehensive SA treatment benefits.
  
  
  METHODS
  SA treatment utilization during 1999 and the relationship between patient cost-sharing, gender, and SA diagnosis on SA treatment utilization were examined using a cross-sectional retrospective analysis.
  
  
  RESULTS
  Only 0.37% (n=1230) of adults had a SA related claim during 1999. Individuals in plans with higher levels of cost-sharing had lower rates of residential SA treatment and specialty SA outpatient treatment compared to individuals in plans with lower cost-sharing, adjusting for age, sex, and SA diagnosis.
  
  
  CONCLUSIONS
  Few individuals had SA related claims, raising questions about rates of undocumented treatment, out-of-network treatment, and unmet need for treatment in the privately insured, and its implications for assessing the quality of SA treatment available in private health plans. At a time when levels of cost-sharing are increasing among privately insured individuals, consideration should be given the potential impact of such changes on the treatment of individuals requiring specialty SA treatment.
authors.affiliation: RAND, Santa Monica, CA 90407, USA. stein@rand.org
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Stein
authors.forename: Weiying
authors.initials: W
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D017047:Cost Sharing / Q000191:economics* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D016320:Substance Abuse Treatment Centers / Q000191:economics* / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000191:economics / Q000628:therapy*