Substance Use Treatment Provider Behavior and Healthcare Reform: Evidence from Massachusetts

Abstract

We examine the impact of the 2006 Massachusetts healthcare reform on substance use disorder (SUD) treatment facilities' provision of care. We test the impact of the reform on treatment quantity and access. We couple data on the near universe of specialty SUD treatment providers in the USA with a synthetic control method approach. We find little evidence that the reform lead to changes in treatment quantity or access. Reform effects were similar among for-profit and non-profit facilities. In an extension, we show that the reform altered the setting in which treatment is received, the number of offered services, and the number of programs for special populations. These findings may be useful in predicting the implications of major health insurance expansions on the provision of SUD treatment. Copyright © 2017 John Wiley & Sons, Ltd.

What factors predict the passage of state‐level e‐cigarette regulations?

“…To address these data limitations, we have estimated an alternative set of regressions in which we utilize the Governor's political party, specifically whether the Governor is a Democrat using data drawn from the University of Kentucky Center for Poverty Research (2016), to proxy for political preferences. We treat the mayor of District of Columbia as the de facto Governor of this locality (Maclean & Saloner, 2018). Results generated in this auxiliary specification are not appreciably different from our core results (reported later in the manuscript), although the coefficient estimates are somewhat less precise (see Tables A1 and A2).…”

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“…Finally, we control for the Governor's political affiliation (Democrat or not) and the state population (University of Kentucky Center for Poverty Research, 2016). We follow Maclean and Saloner (2018) and treat the Mayor of DC as the de facto Governor. We inflate all nominal values to 2013 terms using the Consumer Price Index.…”

“…The SSDI and WC level variables are highly left-skewed. To account for skewness in the benefit level distributions, we use a Poisson generalized linear model (GLM) following a procedure outlined by Manning and Mullahy (2001). 34 Results are reported in Table 14.…”

Massachusetts Substance Use Disorder Treatment Organizations’ Perspectives on the Affordable Care Act: Changes in Payment, Services, and System Design

“…In response to the 2006 Massachusetts reform, SUD treatment providers increased admissions, number of services offered, use of pharmacotherapy, and acceptance of private insurance (Maclean & Saloner, 2015). At the same time, programs for special populations (e.g., seniors, LGBTQ, criminal justice involved) decreased (Maclean & Saloner, 2015).…”

“…At the same time, programs for special populations (e.g., seniors, LGBTQ, criminal justice involved) decreased (Maclean & Saloner, 2015). Decreases in inpatient hospital admission for SUD due to the reform were observed (Meara et al, 2014) along with increased ancillary SUD service use (Maclean & Saloner, 2015), which would be expected following an insurance expansion as people with SUDs then would have access to treatment outside of the inpatient setting. However, another study found the reform did not increase utilization, the percentage of uninsured patients with SUDs remains high, and copays for those with insurance were barriers to treatment (Capoccia et al, 2012).…”