Spending trends on substance abuse treatment under private employer-sponsored insurance, 2001–2009
Introduction
Substance abuse spending under private insurance has been falling in nominal dollars for a number of years: from $2444 million in 1986 to $2239 million in 2003 (Substance Abuse and Mental Health Services Administration, 2010). It rose slightly to $2613 million in 2005. This decline was confirmed through analyses of claims data from privately insured individuals with employer-sponsored health plans from 1992 through 2001. The claims analysis also revealed that underlying the declining expenditures were significant decreases in substance abuse service utilization, such as hospital admissions and length of stay (Mark and Coffey, 2004).
Falling spending and use of substance abuse services under private insurance is concerning in light of the significant unmet need for substance abuse treatment among those with private insurance. The 2009 National Survey on Drug Use and Health (United States Department of Health and Human Services, 2010) indicates that 7.7% of individuals with private insurance have a diagnosable drug or alcohol use disorder (1.8% for illicit drug use or dependence and 6.7% for alcohol abuse or dependence). Yet, only 6.9% of those with a substance use disorder with private insurance receive any treatment and only 3.9% receive treatment from a specialty provider (Bouchery et al., in press).
Given recent changes in substance abuse treatment technologies, as well as changes in policies that affect substance abuse financing, a more up-to-date analysis of spending and use for substance abuse treatment under private insurance is needed. In particular, since the mid-1990s, several new pharmacotherapies have been introduced to treat addiction including naltrexone, acamprosate, and buprenorphine. The introduction of these medications may have led to an increase in the number of individuals receiving some type of substance abuse treatment and also may have altered spending patterns. Additionally, as a result of the Mental Health Parity and Addiction Equity Act (MHPAEA), most private plans that offer substance abuse coverage are required to provide insurance benefits that are equally generous to those offered for medical services by at least 2011.
The present study identifies recent trends from 2001 through 2009 in spending and utilization on substance abuse services by individuals with employer-sponsored health insurance. This information will reveal how access, utilization, expenditures, and the mix of substance abuse treatment services may have changed in recent years and will provide a baseline for assessing changes that may occur as a result of recent policy changes.
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Methods
The analyses were based on data from the MarketScan Commercial Claims and Encounters Database which comprises insurance claims data from self-insured employer-sponsored group health plans (Hansen, 2010). The employers are primarily Fortune 300 firms; their average number of enrollees is 126,000, with a range of approximately 7000–1.8 million. The analysis focused on the period from 2001 through 2009. Data are from all plans offered by approximately 100 employers each year, with some
Results
Table 1 presents all disease and substance abuse treatment expenditures per enrollee from 2001 through 2009. In 2009, the average annual substance abuse spending per enrollee was about $18. Spending on substance abuse treatment comprised 0.31–0.39% of total health spending that was reimbursed under the health plans. The percentages shifted only slightly across the time period, without an upward or downward monotonic trend. The fact that substance abuse spending remained a relatively constant
Discussion
In contrast to prior analyses of substance abuse spending under private insurance, we found that substance spending per enrollee rose in real dollars from 2003 through 2009. The growth in substance abuse spending was about equivalent to that of all health care expenditures; thus, substance abuse spending remained a relatively constant share of all health care spending (at 0.30–0.40%). Approximately 31% of the increase in substance abuse spending was attributable to growth in outpatient
Role of funding source
This study was funded under a contract from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institute of Drug Abuse (NIDA). The opinions expressed do not necessarily reflect those of SAMHSA, NIDA, or the Department of Health and Human Services.
Contributors
The funders were involved in the design of the study, the development of the analysis plan, the interpretation of the results, and the writing of the manuscript.
Conflict of interest
No conflict declared.
Acknowledgement
We would like to acknowledge the programming and analytic support of Kay Miller.
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