Objective: To examine the potential effects of the introduction and expansi
on of managed care on the financing and organization of public and private
alcohol and drug abuse treatment systems by reviewing studies on managed ca
re and substance abuse.
Study Design: Spending on treatment for alcohol and drug abuse, the organiz
ation of treatment, treatment workforce composition, provision of services,
and their implications for access and treatment outcome were examined by r
eview 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 as
sociated with alcohol and drug treatment, it also presents additional barri
ers to access and improving treatment outcome.
Conclusions: The review suggests that organizational approaches, particular
ly the settings in which treatment is placed, will differ in their impact o
n ties between treatment agencies and the medical community, and ties with
other health and social service agencies. Also of importance is a new empha
sis on accountability of treatment through the mechanisms of outcomes monit
oring and performance indicators. It remains to be seen whether these innov
ations will be meaningfully linked with outcomes research. It is incumbent
on researchers and clinicians to explore these issues.