The impact of managed care on substance abuse treatment: A report of the American Society of Addiction Medicine

This report examines the impact of managed care (MC) and related developmen ts on substance abuse treatment, and evaluates how it has been associated w ith a decline in the availability of proper treatment for many addicted pat ients. A trend toward carve-out and for-profit MC organizations is associat ed with lower financial incentives for intensive treatment than in earlier staff-model and not-for-profit MC organizations. The value of substance abu se insurance coverage has declined by 75% between 1988 and 1998 for employe es 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 wit h a drastic reduction in frequency and duration of inpatient hospitalizatio n, and there is no clear evidence that this reduction has been offset by a corresponding increase in outpatient support. In a survey of physicians tre ating addiction, the majority felt that MC had a negative impact on dt toxi fication and rehabilitation, and on their ethical practice of addiction med icine.