Health Services Financing and the Availability of Services in Community-Based Substance Abuse Treatment Programs

Background: When the Affordable Care Act is fully implemented it is estimated that approximately 32 million Americans will gain access to publically available health insurance.  Approximately 11 million of these individuals will have some form of substance use and/or mental disorders that may pay for direct clinical services but not for other core and supportive services. Understanding the role of financing in driving services will be critical in the planning and development of new systems of care that can meet increasing mandates for improved quality of care.  This study builds on previous work and will examine characteristics of financing in community-based treatment facilities as predictors of the programs ability to offer both core and supportive treatment services to their clients.

Methods: Data for this study were drawn from the National Survey of Substance Abuse Treatment Services (N-SSATS) which was sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) conducted in 2011.  The sample included 11,101 facilities providing regular outpatient care.  A measure of core support services was developed counting 9 different kinds of core services (comprehensive diagnosis, individual and group therapy, relapse prevention, urine screening, etc) and social support services counting 11 different kinds of ancillary care (child care, transportation services, employment services, etc.).  These measures were then subjected to interdependence analysis, including cluster analysis, on various payment types within regular outpatient treatment facilities (self-pay, private health insurance, Medicare, Medicaid, state financed health insurance, Federal military insurance, and Access to Recovery Vouchers).

Findings: The findings show that financing strategies such sliding-scale and self-payment, Medicare and Medicaid, state financed insurance, and private insurance are important predictors of core and added support services. Important differences by payment type are also explored.

Implications: The use of financial analysis has significant implications for both policy makers and treatment programs as financing for direct care and support services shifts.  Decision-makers will need to clearly identify how and why they are funding services within programs they control.  Treatment programs will need to become increasingly conversant with the various insurance and other financing options are available for their patients and how to use those payment strategies to create a comprehensive system of care for clients under health reform.  Finally, the implications the social work profession investing in and making applied health services research a research priority to help improve access to care and quality outcomes will be discussed.