Health Insurance Coverage and the Receipt of Specialty Treatment for Substance Use Disorders Among U.S. Adults

Abstract

Objective Examine the association between private health insurance and the receipt of specialty substance use disorder treatment. Methods Weighted logistic regressions were estimated to examine the association between health insurance and the receipt of any specialty substance use disorder treatment in national samples of non-elderly adults with alcohol abuse/dependence (N=22,778), alcohol dependence (N=10,104), drug abuse/dependence (N=9,427), and drug dependence (N=6,736). Analyses compared receipt of any specialty substance use treatment among the uninsured to the privately insured who reported known coverage, no coverage, or unknown coverage for alcohol/drug treatment. Regressions adjusted for sociodemographic characteristics, treatment need, and criminal justice involvement. Results Compared to being uninsured, private insurance with known coverage for alcohol treatment was associated with greater use of any specialty treatment only among those with alcohol dependence (p<0.05). Conclusion Private insurance is associated with increased use of specialty treatment among those with severe alcohol use disorders who understand their benefits.

Private health insurance coverage of drug use disorder treatment: 2005–2018

“…The results of this study were different from the results of an earlier study based on 2005-2009 NSDUH that also examined the association of private insurance coverage of drug use treatment with actual use of treatmen services [16]. That study found that 19.8% of those with coverage vs. 6.7% of those without coverage used services.…”

“…While little is known about changes in rates of coverage of substance use treatment services in private insurance plans following implementation of ACA, there is some evidence of increased use of mental and substance use treatment services in the post-ACA period. Much of research on the impact of ACA on mental health and substance use services, however, has focused on Medicaid expansion [9][10][11][12][13][14][15][16]. This focus is appropriate because Medicaid is a major source of funding for mental health and substance use treatment and a large proportion of adults with these disorders qualify for Medicaid.…”

“…The study also examines the association of such coverage with actual treatment for drug use disorders. An earlier study using NSDUH data examined association of health insurance, including private health insurance, with receipt of substance use treatment [16]. However, that study covered years 2005-2009-the period before implementation of MHPAEA and ACA-and examined association of insurance coverage with treatment seeking for either alcohol or drug use disorder.…”

Health Plans’ Early Response to Federal Parity Legislation for Mental Health and Addiction Services

“…We did not collect information on denial rates, appeals, or complaints about individual experiences. Finally, improved access to coverage is necessary to reduce the treatment gap, but other factors, including enrollee awareness of coverage and desire to use services, are also important (24) and were not measured in this study.…”

How Do People Who Frequently Attend Emergency Departments for Alcohol-Related Reasons Use, View, and Experience Specialist Addiction Services?

“…Common structural factors include lack of service provision (Probst, Manthey, Martinez, & Rehm, 2015); lack of information about services (Harris et al, 2013;Probst et al, 2015); costs, including travel and childcare costs (Grant, 1997); service inflexibility, particularly in relation to opening times (Cummings, Wen, Ritvo, & Druss, 2014;Rapp et al, 2006); and lack of community outreach (Grant, 1997;Saunders, Zygowicz, & D' Angelo, 2006). More individual barriers to accessing alcohol treatment include perceived feelings of stigma, shame, and embarrassment (Browne et al, 2016;Fortney et al, 2004;Grant, 1997;Keyes et al, 2010;Probst et al, 2015;Wallhed Finn, Bakshi, & Andreasson, 2014); problem denial or ambivalence to change (Edlund, Booth, & Feldman, 2009;Edlund, Unutzer, & Curran, 2006;Grant, 1997;Mojtabai & Crum, 2013;Probst et al, 2015;Rapp et al, 2006;Saunders et al, 2006); fear and concerns about disclosing private information (Rapp et al, 2006); lack of confidence in treatment services (Grant, 1997); and a misperception that treatment requires abstinence (Wallhed Finn et al, 2014).…”