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Healthcare utilization of individuals with substance use disorders following Affordable Care Act implementation in a California healthcare system.
J Subst Abuse Treat. 2020 11; 118:108097.JS

Abstract

BACKGROUND

Practitioners expected the Affordable Care Act (ACA) to increase availability of health services and access to treatment for Americans with substance use disorders (SUDs). Yet research has not examined the associations among ACA enrollment mechanisms, deductibles, and the use of SUD treatment and other healthcare services. Understanding these relationships can inform future healthcare policy.

METHODS

We conducted a longitudinal analysis of patients with SUDs newly enrolled in the Kaiser Permanente Northern California health system in 2014 (N = 6957). Analyses examined the likelihood of service utilization (primary care, specialty SUD treatment, psychiatry, inpatient, and emergency department [ED]) over three years after SUD diagnosis, and associations with enrollment mechanisms (ACA Exchange vs. other), deductibles (none, $1-$999 [low] and ≥$1000 [high]), membership duration, psychiatric comorbidity, and demographic characteristics. We also evaluated whether the enrollment mechanism moderated the associations between deductible limits and utilization likelihood.

RESULTS

Service utilization was highest in the 6 months after SUD diagnosis, decreased in the following 6 months, and remained stable in years 2-3. Relative to patients with no deductible, those with a high deductible had lower odds of using all health services except SUD treatment; associations with primary care and psychiatry were strongly negative among Exchange enrollees. Among non-Exchange enrollees, patients with deductibles were more likely than those without deductibles to receive SUD treatment. Exchange enrollment compared to other mechanisms was associated with less ED use. Psychiatric comorbidity was associated with greater use of all services. Nonwhite patients were less likely to initiate SUD and psychiatry treatment.

CONCLUSIONS

Higher deductibles generally were associated with use of fewer health services, especially in combination with enrollment through the Exchange. The role of insurance factors, psychiatric comorbidity and race/ethnicity in health services for people with SUDs are important to consider as health policy evolves.

Authors+Show Affiliations

Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America. Electronic address: derek.satre@ucsf.edu.Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America.Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America.Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America.Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America.Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, San Francisco, CA 94118, United States of America.Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

32972648

Citation

Satre, Derek D., et al. "Healthcare Utilization of Individuals With Substance Use Disorders Following Affordable Care Act Implementation in a California Healthcare System." Journal of Substance Abuse Treatment, vol. 118, 2020, p. 108097.
Satre DD, Palzes VA, Young-Wolff KC, et al. Healthcare utilization of individuals with substance use disorders following Affordable Care Act implementation in a California healthcare system. J Subst Abuse Treat. 2020;118:108097.
Satre, D. D., Palzes, V. A., Young-Wolff, K. C., Parthasarathy, S., Weisner, C., Guydish, J., & Campbell, C. I. (2020). Healthcare utilization of individuals with substance use disorders following Affordable Care Act implementation in a California healthcare system. Journal of Substance Abuse Treatment, 118, 108097. https://doi.org/10.1016/j.jsat.2020.108097
Satre DD, et al. Healthcare Utilization of Individuals With Substance Use Disorders Following Affordable Care Act Implementation in a California Healthcare System. J Subst Abuse Treat. 2020;118:108097. PubMed PMID: 32972648.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Healthcare utilization of individuals with substance use disorders following Affordable Care Act implementation in a California healthcare system. AU - Satre,Derek D, AU - Palzes,Vanessa A, AU - Young-Wolff,Kelly C, AU - Parthasarathy,Sujaya, AU - Weisner,Constance, AU - Guydish,Joseph, AU - Campbell,Cynthia I, Y1 - 2020/08/04/ PY - 2020/01/13/received PY - 2020/06/24/revised PY - 2020/07/25/accepted PY - 2020/9/25/entrez PY - 2020/9/26/pubmed PY - 2021/7/29/medline KW - Affordable Care Act KW - Deductible KW - Health insurance KW - Mental health KW - Race/ethnic disparities KW - Substance use disorder SP - 108097 EP - 108097 JF - Journal of substance abuse treatment JO - J Subst Abuse Treat VL - 118 N2 - BACKGROUND: Practitioners expected the Affordable Care Act (ACA) to increase availability of health services and access to treatment for Americans with substance use disorders (SUDs). Yet research has not examined the associations among ACA enrollment mechanisms, deductibles, and the use of SUD treatment and other healthcare services. Understanding these relationships can inform future healthcare policy. METHODS: We conducted a longitudinal analysis of patients with SUDs newly enrolled in the Kaiser Permanente Northern California health system in 2014 (N = 6957). Analyses examined the likelihood of service utilization (primary care, specialty SUD treatment, psychiatry, inpatient, and emergency department [ED]) over three years after SUD diagnosis, and associations with enrollment mechanisms (ACA Exchange vs. other), deductibles (none, $1-$999 [low] and ≥$1000 [high]), membership duration, psychiatric comorbidity, and demographic characteristics. We also evaluated whether the enrollment mechanism moderated the associations between deductible limits and utilization likelihood. RESULTS: Service utilization was highest in the 6 months after SUD diagnosis, decreased in the following 6 months, and remained stable in years 2-3. Relative to patients with no deductible, those with a high deductible had lower odds of using all health services except SUD treatment; associations with primary care and psychiatry were strongly negative among Exchange enrollees. Among non-Exchange enrollees, patients with deductibles were more likely than those without deductibles to receive SUD treatment. Exchange enrollment compared to other mechanisms was associated with less ED use. Psychiatric comorbidity was associated with greater use of all services. Nonwhite patients were less likely to initiate SUD and psychiatry treatment. CONCLUSIONS: Higher deductibles generally were associated with use of fewer health services, especially in combination with enrollment through the Exchange. The role of insurance factors, psychiatric comorbidity and race/ethnicity in health services for people with SUDs are important to consider as health policy evolves. SN - 1873-6483 UR - https://www.unboundmedicine.com/medline/citation/32972648/Healthcare_utilization_of_individuals_with_substance_use_disorders_following_Affordable_Care_Act_implementation_in_a_California_healthcare_system_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0740-5472(20)30353-6 DB - PRIME DP - Unbound Medicine ER -