Services for Substance Abusers in a Changing Health Care System

Abstract

Many managed care plans may need to modify their coverage to address substance abusers' multidimensional physical, mental, and social problems. Such adjustments are particularly important for public sector clients whose addiction-related problems are typically more severe than those of private sector patients. Data from a sample of 161 medical emergency, primary care, mental health, and substance abuse treatment programs in Dade County, Florida, reveal highly varied perceptions of managed care. They illustrate that the relevance of provider organization ownership, type of services, and populations served for behavioral managed care analysis. Further implications are the need to provide “wrap-around” or enabling services and to coordinate care for substance abusers to avoid displacement of responsibility for critical aspects of their care onto overwhelmed “safety net” agencies.

Health Care Utilization Among Drug-Using and Non-Drug-Using Women

“…16,21,22,26,27 Identifying additional determinants or barriers to health care utilization among women of different age groups and with differing risks (i.e., drug use) is necessary for development of effective public health policy, as well as for the potential success of health care service systems in the era of managed care. 30 …”

A behavioral typology of opioid overdose risk behaviors among recent veterans in New York City

“…Typologies of the sort identified here thus reinforce the need for patient management that seeks a more holistic understanding of individual health care and substance abuse treatment needs. Researchers working with veteran and substance-using populations have long argued the value of “wrap-around” interventions [54–56] and forms of outreach that coordinate different healthcare and social service modalities through an active dialogue among practitioners about the unique needs of individuals. More recently this approach has been reinvigorated through advances in the patient-centered medical home model [57–60], an approach to health care that involves both dialogue among care and service providers and the central role of a patient care coordinator [61, 62], which in some instances involves peers who share critical life experiences with patients [63–65].…”

Managed Care's Dual Impact on Outpatient Substance Abuse Treatment: Methadone Maintenance vs. Drug Free

“…In two county-based surveys, McNeese-Smith (1998) reports that 38% of surveyed SAT program directors in Los Angeles County eliminated some services in response to managed care, and Rivers (1998) reports that 20% of surveyed SAT program directors in Miami-Dade County claim MC caused reduced availability and accessibility of SAT services. Lemak & Alexander (2001) find that MC is associated with (as opposed to causes) shorter treatment durations and fewer individual and group therapy sessions in OSAT.…”