Drug and alcohol treatment among privately insured patients: rate of specialty substance abuse treatment and association with cost-sharing.

OBJECTIVE: To examine the rate of formal substance abuse (SA) treatment in a privately insured population, and the association between cost-sharing, residential treatment, and outpatient SA treatment, we analyzed claims data for 332442 adults in 41 health plans with comprehensive SA treatment benefits.

DESIGN: SA treatment utilization during 1999 and the relationship between patient cost-sharing, gender, and SA diagnosis on SA treatment utilization were examined using a cross-sectional retrospective analysis.

RESULTS: Only 0.37% (n=1230) of adults had a SA related claim during 1999. Individuals in plans with higher levels of cost-sharing had lower rates of residential SA treatment and specialty SA outpatient treatment compared to individuals in plans with lower cost-sharing, adjusting for age, sex, and SA diagnosis.

CONCLUSIONS: Few individuals had SA related claims, raising questions about rates of undocumented treatment, out-of-network treatment, and unmet need for treatment in the privately insured, and its implications for assessing the quality of SA treatment available in private health plans. At a time when levels of cost-sharing are increasing among privately insured individuals, consideration should be given the potential impact of such changes on the treatment of individuals requiring specialty SA treatment.