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October 19, 2001
Growth of Managed Care in Substance Abuse Treatment |
In Brief |
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Managed care has become an integral and expanding part of the U.S. health care system. The structure of managed care in the behavioral health system continues to undergo change. Many public sector and other substance abuse and mental health programs are now managed by public sector agencies or public or private partnerships rather than by private managed care organizations.1 Contracts between State Medicaid and managed care organizations have increased in complexity. There is growing concern about the impact of managed care on substance abuse treatment2 and, indeed, one of the strategic goals of the Substance Abuse and Mental Health Services Administration (SAMHSA) is to improve managed care outcomes. This report uses information from SAMHSA’s Uniform Facility Data Set (UFDS) survey to examine trends in the number of substance abuse treatment facilities that contract with managed care organizations. UFDS is an annual survey of all facilities in the United States, both public and private, that provide substance abuse treatment. Information on managed care contracts has been collected in the UFDS survey since 1995. The number of facilities reporting to UFDS increased by 42 percent between 1995 and 1999 (Table 1). SAMHSA has continued efforts to expand survey coverage and to improve response rates. Prior to 1995, UFDS surveyed only facilities that were administratively monitored by State or Federal agencies. In that year, SAMHSA began to identify and survey other facilities, such as privately owned and hospital-based treatment facilities, that had not been included in the UFDS survey universe. |
Facility Ownership Ownership indicates the type of entity owning or responsible for the operation of the facility. Categories used in the UFDS survey are private for-profit, private non-profit, and local, State, Federal, or tribal government (Table 1). Expanded survey coverage resulted in an increase of 70 percent between 1995 and 1999 in the number of private for-profit facilities. The number of private non-profit facilities increased by 39 percent. Despite these substantial increases, the overall structure of the treatment system (as reflected in UFDS ownership data) remained relatively constant. In 1999, private non-profit facilities made up the bulk of the system (60 percent), followed by private for-profit (26 percent), local government (7 percent), State government (4 percent, Federal government (2 percent), and tribal government (1 percent). |
Table 1. Number of Substance Abuse Treatment Facilities, by Ownership: 1995-1999 |
Figure 1. Percent of Facilities with Managed Care Contracts, by Ownership: 1995-1999 | |||||||||||||||||||||||||||||||||||||||||||||||
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Source: SAMHSA Treatment Episode Data Set (TEDS).
Managed Care and Facility Ownership About 54 percent of all facilities had managed care contracts in 1999, as compared to 32 percent in 1995. All ownership categories showed an increase in the percentage with managed care contracts (Figure 1). Privately owned facilities, both non-profit and for-profit, were more likely to have managed care contracts than were government-owned facilities. The percentages of private non-profit and private for-profit facilities with managed care contracts rose from 34 and 43 percent (respectively) in 1995 to 57 and 56 percent (respectively) in 1999. Government-owned facilities were less likely to have managed care contracts. Local government-owned facilities with managed care contracts increased from 22 to 44 percent. Among State-owned facilities, the proportion with managed care contracts rose from 11 to 41 percent; among federally-owned facilities, from 2 to 24 percent; and among tribal government-owned facilities, from 10 to 21 percent. |
Figure 2. Percent of Treatment Facilities with Managed Care Contracts, by
State: 1995 and 1999 |
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1995 | 1999 |
Percent of Treatment
Facilities |
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Managed
Care By State The proportion of managed care facilities increased in all States except Alabama between 1995 and 1999 (Figure 2).
End Notes 2 Galanter, M., Keller, D.S., Dermatis, H., & Egelko, S. (2000). The impact of managed care on substance abuse treatment: A report of the American Society of Addiction Medicine. Journal of Addictive Diseases, 19(3), 13-34. |
The
Drug and Alcohol Services Information System (DASIS) is an integrated data
system maintained by the
Office of Applied
Studies (OAS), Substance Abuse and
Mental Health Services Administration (SAMHSA). One component of DASIS is
the Uniform Facility Data Set (UFDS), an annual survey of all facilities
in the United States, both public and private, that provide substance
abuse treatment. The DASIS Report is prepared by the Office of Applied Studies, SAMHSA; Synectics for Management Decisions, Inc., Arlington, Virginia; and RTI, Research Triangle Park, North Carolina. Information and data for this issue are based on data reported to UFDS for the survey reference dates October 2, 1995, and October 1, 1996-1999. Access the latest UFDS reports at: Access the latest UFDS public use files at: |
The DASIS Report is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report may be downloaded from http://www.oas.samhsa.gov/facts.cfm. Citation of the source is appreciated. Other reports from the Office of Applied Studies are also available on-line at the OAS home page: http://www.oas.samhsa.gov. |
This page was last updated on December 31, 2008. |
SAMHSA, an agency in the Department of Health and Human Services, is the Federal Government's lead agency for improving the quality and availability of substance abuse prevention, addiction treatment, and mental health services in the United States.
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