RELATIONSHIP BETWEEN INPATIENT ALCOHOLISM-TREATMENT AND LONGITUDINAL CHANGES IN HEALTH-CARE UTILIZATION

Objective: The purpose of the study was to evaluate changes in health care utilization associated with inpatient alcoholism treatment in alc oholics of low socioeconomic status with different histories of treatm ent relapse. Method: The sample consisted of more than 85,000 male alc oholics using inpatient care in Department of Veterans Affairs medical centers in fiscal year 1987. Five treatment groups were identified to represent a continuum of length and intensity of alcoholism treatment , including formal inpatient alcoholism treatment, short detoxificatio n and hospitalizations for primary diagnoses other than alcoholism. Al l inpatient and outpatient health services for 3 years before and 3 ye ars after the index hospitalization were examined for differential cha nges in utilization associated with the five treatment groups after co ntrolling for patient predisposing, enabling and need characteristics. Results: Both total inpatient days and outpatient visits increased si gnificantly for all treatment groups, with the greatest increases occu rring in the group completing inpatient alcoholism treatment (both p<. 0001). However, use of inpatient medical care decreased and substance abuse inpatient care increased significantly for most groups, with the largest increases in substance abuse care found for the completed tre atment group. Conclusions: In a hospital system that does not deny car e on the basis of ability to pay, certain groups of chronic alcoholics who cannot sustain prolonged remission will continue to be heavy util izers of services. Alcoholism treatment may be associated with higher short-term costs but it remains to be seen whether provision of more f ocused treatment services is able to achieve longer term better outcom es and, ultimately, lower costs.